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This is an open-label, multicenter, Phase I/II study designed to evaluate the safety, tolerability, pharmacokinetic characteristics, and preliminary efficacy of EMB-07 combination therapy in adult patients with aggressive B-cell non-Hodgkin lymphoma (B-NHL). The study consists two phases: Phase I of dose escalation and Phase II of dose expansion. Approximately 115 patients will be enrolled in this study (i.e., 5 cohorts of approximately 23 patients per cohort). Multiple EMB-07-based combination regimens will be evaluated in patients with relapsed/refractory (R/R) aggressive B-NHL (Cohort A) and patients with newly diagnosed aggressive B-NHL (Cohort B).
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Phase I: Dose Escalation, Phase II: Dose Expansion | Experimental | Phase I: Dose Escalation During the dose escalation, the planned starting dose of EMB-07 is 6 mg. A dose escalation scheme of "3+3" will be followed to determine DLT, MTD, and RP2CD. Phase II: Dose Expansion For each cohort: During the dose-expansion, approximately 10 to 15 patients will be enrolled and administrated in each cohort to further characterize the safety profile and anti-tumor activity of the combination therapies. Approximately 20 patients per cohort receiving RP2CD will be pooled from the dose escalation and dose expansion phases to evaluate preliminary efficacy signals. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| EMB07 | Drug | EMB-07 is a bispecific antibody targeting CD3 and receptor-tyrosine-kinase-like orphan receptor 1 [ROR1] |
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| Measure | Description | Time Frame |
|---|---|---|
| Maximum tolerated dose (MTD) of EMB-07(Phase I only) | Up to 28 days | |
| Rate of Adverse Events (AE) and Serious Adverse Events (SAE) | Adverse events and serious adverse events as assessed by CTCAE v5.0 | From enrollment up to 30 days after the last dose |
| Recommended phase II dose (RP2D) of EMB-07 | Up to 28 days | |
| Objective Response Rate (ORR) | Objective response rate, measured by Lugano 2014 | From first dose until the date of first documented progression or date of death from any cause, whichever comes first, up to 2 years |
| Measure | Description | Time Frame |
|---|---|---|
| Duration of Response (DOR) | Time from first study drug dose to first documented disease progression (per Lugano 2014 criteria) or death from any cause, whichever occurs first. | From first dose until the date of first documented progression or date of death from any cause, whichever comes first; up to 2 years |
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Inclusion Criteria:
Cohort B: Newly diagnosed, treatment-naïve DLBCL NOS confirmed by pathology, or t-DLBCL not previously treated with adequate (at least 2 cycles) R-CHOP therapy (excluding Richter transformation or HGBL with BCL2/MYC±BCL6 rearrangements). Patients with newly diagnosed DLBCL NOS should have an International Prognostic Index (IPI) score ≥2 and Ann Arbor stage ≥2. The sponsor will reserve the right to limit the number of t-DLBCL patients enrolled in the study. Other aggressive B-NHLs patients who may benefit from the study treatment can be enrolled after careful risk/benefit assessment by the sponsor and investigator.
Exclusion Criteria:
Current or prior central nervous system (CNS) or meningeal involvement related to the underlying disease.
Cohort A: Prior exposure to any ROR1-targeted agent (e.g., biologic or CAR-T); or Cohort A1: Prior exposure to Gemcitabine-based chemotherapy (≥ 2 consecutive cycles); or Cohort A2: Prior exposure to Polatuzumab Vedotin; or Cohorts A3 and A4: Refractory to prior Lenalidomide/Zanubrutinib or Chidamide therapy, respectively.
Contraindications to any agent included in the combination therapy regimen.
Cohort A: Candidates suitable for ASCT or CAR-T cell therapy.
Cohort A: Use of any standard or investigational therapy for the underlying disease within 28 days before C1D1 or 5 half-lives (whichever is shorter), including chemotherapy, immunotherapy, radioimmunotherapy, non-palliative radiotherapy, or any other anti-tumor therapy. Only palliative radiotherapy to non-target lesions will be permitted.
Cohort B: B-NHL with prior receipt of at least 2 consecutive cycles of R-CHOP (prior lymph node biopsy or local radiotherapy will not be an exclusion criterion).
Major surgery or live vaccine administration within 28 days prior to C1D1.
History of allogeneic hematopoietic stem cell transplantation or solid organ transplantation (except corneal transplantation). In addition, patients who received ASCT within 3 months before C1D1, CAR-T within 6 months before C1D1, or diagnosed with graft-versus-host disease (GVHD) will be excluded.
Any AE related to prior therapy (excluding alopecia) that has not resolved to Grade ≤ 1 (per the Common Terminology Criteria for Adverse Events [CTCAE], Version 5.0) or baseline at C1D1.
Active hepatitis B virus (HBV) or hepatitis C virus (HCV) infection at screening. Patients with positive HBsAg and/or positive HBcAb but negative HBV DNA will be eligible for enrollment. Patients with positive HCV antibody but negative HCV RNA are also eligible for enrollment.
Known positive HIV serology or history of active viral infection
Active infection requiring parenteral antibiotics, antivirals, or antifungals within 14 days before C1D1; prophylactic use of these agents (including parenteral administration) will be permitted.
Prior malignancy requiring treatment or with evidence of recurrence within 5 years before C1D1 (except non-melanoma skin cancer or adequately treated carcinoma in situ of the cervix). Patients with a history of cancer treated with curative intent > 5 years before C1D1 and no evidence of recurrence will be eligible.
Ischemic or hemorrhagic stroke of Grade ≥ 3, or gastrointestinal bleeding of Grade ≥ 3, within 6 months before C1D1.
Active, unstable cardiovascular function:
Known or suspected history of hemophagocytic lymphohistiocytosis (HLH);
Known history of progressive multifocal leukoencephalopathy;
Active autoimmune disease requiring treatment
Prior systemic immunosuppressive medication (including but not limited to cyclophosphamide, azathioprine, methotrexate, thalidomide, and anti-tumor necrosis factor agents) within 28 days before C1D1.
Systemic corticosteroid use within 2 weeks before study treatment at a dose equivalent to > 10 mg/day Prednisone. Inhaled, topical, or ophthalmic steroids will be permitted. Short-term corticosteroid use (e.g., prophylaxis for intravenous contrast) will be permitted.
Any other severe underlying medical condition (e.g., active gastric ulcer, uncontrolled seizures, cerebrovascular event, gastrointestinal bleeding, coagulation/thrombotic disorders with severe signs/symptoms, cardiac disease), or psychiatric, psychological, familial, or geographic factors that, in the investigator's judgment, possibly interfere with scheduled disease assessments, treatment, and follow-up, compromise patient compliance, or place the patient at high risk of treatment-related complications.
Female patients who are pregnant or breastfeeding. Abuse of alcohol, cannabis-derived products, or other controlled substances.
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Xikang Xu | Contact | 86-21-61951000 | xkxu@epimab.com |
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| Rituximab/Gemcitabine/Oxaliplatin | Drug | Rituximab is a monoclonal antibody drug specifically targeting the CD20 antigen. Gemcitabine is a chemotherapy drug classified as an antimetabolite. Oxaliplatin is a platinum-based chemotherapy drug. |
|
| Duration of Complete Response(DOCR) |
Time from first study drug dose to first documented disease progression (per Lugano 2014 criteria) or death from any cause, whichever occurs first. |
| From first dose until the date of first documented progression or date of death from any cause, whichever comes first; up to 2 years |
| Time to Treatment Response(TTR) | Time from first study drug dose to first documented disease progression (per Lugano 2014 criteria) or death from any cause, whichever occurs first. | From first dose until the date of first documented progression or date of death from any cause, whichever comes first; up to 2 years |
| Time to Complete Response(TTCR) | Time from first study drug dose to first documented disease progression (per Lugano 2014 criteria) or death from any cause, whichever occurs first. | From first dose until the date of first documented progression or date of death from any cause, whichever comes first; up to 2 years |
| Event-Free Survival(EFS) | Time from first study drug dose to first documented disease progression (per Lugano 2014 criteria) or death from any cause, whichever occurs first. | From first dose until the date of first documented progression or date of death from any cause, whichever comes first; up to 2 years |
| Progression Free Survival (PFS) | Time from first study drug dose to first documented disease progression (per Lugano 2014 criteria) or death from any cause, whichever occurs first. | From first dose until the date of first documented progression or date of death from any cause, whichever comes first; up to 2 years |
| Overall Survival(OS) | Time from first study drug dose to first documented disease progression (per Lugano 2014 criteria) or death from any cause, whichever occurs first. | From first dose until the date of first documented progression or date of death from any cause, whichever comes first; up to 2 years |
| Maximum Plasma Concentration (Cmax) of EMB-07 | Maximum observed plasma concentration of EMB-07, quantified by a validated liquid chromatography-tandem mass spectrometry (LC-MS/MS) assay using human plasma samples. | From predose up to 3 months after first dose |
| Time to Maximum Plasma Concentration (Tmax) of EMB-07 | Time from study drug administration to the time of maximum measured plasma concentration of EMB-07, quantified by validated LC-MS/MS assay using human plasma samples. | From predose up to 30 days after the last dose |
| Trough Serum Concentration (Ctrough) of EMB-07 | Minimum observed serum concentration of EMB-07, measured immediately prior to the next scheduled dose (trough), quantified by validated LC-MS/MS assay using human serum samples. | From predose up to 30 days after the last dose |
| Anti-Drug Antibody (ADA) Positive Rate of EMB-07 | Percentage of subjects testing positive for anti-EMB-07 binding antibodies in serum samples, detected by a validated electrochemiluminescence (ECL) immunoassay. | From predose up to 30 days after the last dose |
| ID | Term |
|---|---|
| D000069283 | Rituximab |
| C508870 | gemcitabine-oxaliplatin regimen |
| ID | Term |
|---|---|
| D058846 | Antibodies, Monoclonal, Murine-Derived |
| D000911 | Antibodies, Monoclonal |
| D000906 | Antibodies |
| D007136 | Immunoglobulins |
| D007162 | Immunoproteins |
| D001798 | Blood Proteins |
| D011506 | Proteins |
| D000602 | Amino Acids, Peptides, and Proteins |
| D012712 | Serum Globulins |
| D005916 | Globulins |
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