LAUSR

The epidermal growth factor receptor (EGFR) is a known driver of cancer growth and the leucine-rich, repeat-containing, G-protein coupled receptor 5 (LGR5) is a transmembrane receptor expressed on cancer stem cells. Petosemtamab is a human, common light chain, IgG1 bispecific antibody with enhanced ADCC activity targeting EGFR and LGR5, which has shown potent antitumor activity in patient (pt)-derived xenograft models of gastric and esophageal cancer. The dose escalation part of an ongoing phase 1/2 study is completed (JCO 2021:39.3 Sup 62). In the expansion part, petosemtamab is being investigated at the RP2D (1500 mg Q2W, 4-week cycle) in pts with selected advanced solid tumors, including GEA. Primary objective (expansion): investigator-assessed ORR per RECIST 1.1. Secondary objectives: ORR, DOR, PFS (per investigator and central review), OS, and safety and tolerability. Key eligibility criteria: advanced/metastatic GEA, prior exposure to ≥2 lines of standard therapy, ECOG PS 0-1, measurable disease (RECIST 1.1), available baseline tumor biopsy. At the data cutoff date of 24 October 2022, 14 GEA pts were treated at the RP2D. Median age was 63 years (range 40-80), ECOG PS 0/1: 3/11 pts, and 79% of pts were male. Primary tumor locations were esophagus (57%), stomach (36%), and gastroesophageal junction (7%), and all were adenocarcinoma histology. Pts received a median of 3 lines of prior systemic therapy (range 1-4) including platinum-based chemotherapy (100%) and checkpoint inhibitors (14%). 3/14 pts had EGFR overexpression (H score ≥200). A median of 2 treatment cycles (range 1-24) was administered, with 1 pt continuing therapy at the cutoff. Among the 14 pts evaluable for efficacy (≥2 cycles and ≥1 postbaseline scan, or early progression) limited activity was seen, however 1 pt with tumor EGFR protein overexpression and gene copy number amplification (CNA) showed a confirmed sustained PR (67% tumor reduction; response ongoing after 24 cycles) and 3 pts had SD (1 with EGFR overexpression and gene CNA; 2 not evaluable for IHC), with tumor reductions of 2%, 17%, and 40%. Among 78 pts treated at the RP2D (escalation and all expansion cohorts; cutoff 28 November 2022), the most frequent AEs regardless of causality (all grades/G3-4) were rash (33%/0%), hypotension (26%/6%), dyspnea (26%/4%), nausea (26%/1%), dermatitis acneiform (24%/1%), blood magnesium decreased (19%/5%), erythema (19%/0%), diarrhea (19%/0%); IRRs (composite term) were reported in 74%/21% of pts, mostly at the first infusion, and all resolved. 5 pts (6%) discontinued treatment due to IRRs on Day 1. 1 esophageal cancer pt died due to unrelated G5 GI bleeding. Petosemtamab demonstrated promising clinical efficacy among patients with pretreated GEA having EGFR gene amplification and/or overexpression, with a manageable safety profile. Citation Format: Marc Díez García, Antoine Hollebecque, Rocio Garcia-Carbonero, Christiane Jungels, Elisabeth Smyth, Shumei Kato, Guillem Argilés, Carlos Gomez Martin, Marina Magin, Yu-Ming Shen, Renée de Leeuw, Mohamed Bekradda, Eduardo Pennella, Ernesto Wasserman, Viktoriya Stalbovskaya, Jeroen Lammerts van Bueren, Aline Engbers, Andrew Joe, Josep Tabernero. MCLA-158 (petosemtamab), an IgG1 bispecific antibody targeting EGFR and LGR5, in advanced gastric/esophageal adenocarcinoma (GEA) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 2 (Clinical Trials and Late-Breaking Research); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(8_Suppl):Abstract nr CT156.