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Summary Introduction Study Objectives Methods Results Zanubrutinib for the Treatment of Patients With Waldenström Macroglobulinemia: Abstract EP1168 Three Years of Follow‑Up Stephen Opat, FRACP, FRCPA, MBBS1,2; Constantine S. Tam, MBBS, MD, FRACP, FRCPA3‑6; Paula Marlton, MBBS (Hons), FRACP, FRCPA7,8; David Gottlieb, MBBS, MD, FRACP, FRCPA9; David Simpson, MBChB, FRACP, FRCPA10,11; Gavin Cull, MB, BS, FRACP, FRCPA12,13; David Ritchie, MD, PhD3,5,6; Emma Verner, MBBS, BMedSci, FRCPA, FRACP14,15; Javier Munoz, MD, MS, FACP16; Alessandra Tedeschi, MD17; Jane Huang, MD11; William Novotny, MD11; Ziwen Tan18; Eric Holmgren, PhD11; Siminder K. Atwal, PhD11; John F. Seymour, MBBS, FRACP, PhD3,5,6; Andrew W. Roberts, MBBS, PhD, FRACP, FRCP3,5,6; and Judith Trotman, MBChB, FRACP, FRCPA14,15 1Monash Health, Clayton, Victoria, Australia; 2Monash University, Clayton, Victoria, Australia; 3Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; 4St Vincent’s Hospital, Fitzroy, Victoria, Australia; 5University of Melbourne, Parkville, Victoria, Australia; 6Royal Melbourne Hospital, Parkville, Victoria, Australia; 7Princess Alexandra Hospital, Brisbane, Queensland, Australia; 8University of Queensland, Brisbane, Queensland, Australia; 9Faculty of Medicine and Health, University of Sydney, Westmead Hospital, Sydney, NSW, Australia; 10North Shore Hospital, Auckland, New Zealand; 11BeiGene USA, Inc., San Mateo, CA, USA; 12Sir Charles Gairdner Hospital, Perth, WA, Australia; 13University of Western Australia Perth, WA, Australia; 14Concord Repatriation General Hospital, Concord, NSW, Australia; 15University of Sydney, Concord, NSW, Australia; 16Banner MD Anderson Cancer Center, Gilbert, AZ, USA; 17ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; 18BeiGene (Beijing) Co., Ltd., Beijing, China. INTRODUCTION RESULTS • Bruton tyrosine kinase (BTK) is an integral component of the B‑cell receptor Figure 2. Disposition of Patients With WM Figure 3. Best Overall Response by MYD88 and CXCR4 Mutation Status in All WM Patients Figure 6. Changes in Hemoglobin and IgM Levels Over Time Figure 9. Incidence of AEs of Interest Over Timea (BCR) pathway which mediates B‑cell proliferation, migration, and adhesion, and 100 50 180 is constitutively activated in Waldenström macroglobulinemia (WM)1‑3 24 TN Enrolled/Safety Population Grade ≥3 thrombocytopeniab 53 R/R 13 4 77ª • 4 escalation, 73 expansion – Inhibitors of BTK have established therapeutic activity in patients with WM 40 160 • Median follow-up: 35.3 mo (4.4-62.1) 29 Median HGB (g/L) Grade ≥3 neutropeniac 13 • Zanubrutinib, a potent, selective, and irreversible BTK inhibitor (BTKi), was 80 36 30 140 designed to maximize BTK occupancy and minimize off‑target inhibition of Grade ≥3 hemorrhage tyrosine protein kinase‑Tec (TEC), interleukin‑2‑inducible T‑cell kinase (ITK), and 19 TN On Study Treatment 5 TN O Treatment 59 5,6 37 R/R 16 R/R epidermal growth factor receptor (EGFR)‑family kinases 56 21 • 8 PD • 10 AEsb • 3 otherc 20 120 Grade ≥3 anemia 60 CR 0-12 months (n=77) • Zanubrutinib was investigated in a first‑in‑human phase 1 / 2 study (AU‑003) 38 Median IgM (g/L) 0 TN Not Evaluable for E cacy VGPR 10 100 Atrial fibrillation/flutter 12-24 months (n=70) designed to evaluate the safety, pharmacokinetics, and antitumor activity of 4 R/R zanubrutinib in patients with B‑cell malignancies 4 • IgM/SPEP <5 g/L at baseline 43 PR 24-36 months (n=61) 0 80 Hypertension – Study includes disease‑specific cohorts, including patients with % Response, 40 MR 24 TN 0 20 40 60 80 100 120 140 160 180 200 220 treatment‑naïve (TN) and relapsed / refractory (R / R) WM E cacy Population 55 SD Months Grade ≥3 infectiond 73 49 R/R No. of patients – Enrollment is complete, and a total of 384 patients have been dosed in this • Median follow-up: 33.5 mo (4.4-62.1) IgM 69 66 63 60 61 64 67 55 7 38 37 23 32 22 28 5 16 13 15 18 11 5 18 6 12 6 4 4 5 4 4 study, including 77 patients with WM 28 Hb 73 73 69 65 67 67 67 59 7 39 37 35 53 25 29 5 17 14 15 10 14 18 7 13 5 7 4 4 5 4 4 Opportunistic infectione 14 Note: Shaded areas show the error bars associated with each assessment. Four patients in the efficacy‑evaluable set did not have IgM test results at baseline. Response assessments for these 20 38 At a median follow‑up of 35.3 months, we report safety and efficacy data for the 19 TN 5 TN patients were based on SPEP M‑protein. • On Study treatment O Treatment HGB, hemoglobin; IgM, immunoglobulin M; SPEP, serum protein electrophoresis. 77 patients with WM treated with single‑agent zanubrutinib 34 R/R 15 R/R Pneumonia/Lung infection 53 20 • 8 PD • 10 AEsb • 2 other 10 14 9 Table 3. Safety Summary 0 10 20 30 40 50 Data cutoff: January 29, 2020. 0 3 Patients, % AE, adverse event; IgM, immunoglobulin M; PD, progressive disease; R/ R, relapsed / refractory; SPEP, serum protein electrophoresis; TN, treatment naïve; WM, Waldenström L265P WT L265P WHIM L265P UNK WT WT TN R / R Overall macroglobulinemia. MYD88 /CXCR4 MYD88 /CXCR4 MYD88 /CXCR4 MYD88 /CXCR4 Data cutoff: January 29, 2020. STUDY OBJECTIVES aWM patients with no prior BTK inhibitor exposure (1 patient was excluded as had prior ibrutinib). bDetailed in Table 3. cRadiation / transplant (n=1), noncompliance (n=1), and investigator Event, n (%) (n=24) (n=53) (N=77) AE, adverse event. a b c d decision (n=1). n=39 n=11 n=7 n=8 Pooled terms where appropriate. Thrombocytopenia or platelet count decreased. Neutropenia, neutrophil count decreased, or febrile neutropenia. All infection e Data cutoff: January 29, 2020. Any AE 24 (100) 53 (100) 77 (100) terms pooled. Only grade ≥3 infections reported here. Opportunistic infections and pneumonia / lung infections are a subgroup of all pooled infections. CR, complete response; MR, minor response; PR, partial response; SD, stable disease; UNK, unknown; VGPR, very good partial response; WM, Waldenström macroglobulinemia; WT, wild‑type. • The objectives of this analysis were to evaluate safety, pharmacokinetics, and Grade ≥3 AEs 11 (45.8) 37 (69.8) 48 (62.3) preliminary efficacy of zanubrutinib monotherapy in patients with TN or R/ R WM Table 1. Patient and Disease Characteristics Serious AEs 5 (20.8) 34 (64.2) 39 (50.6) Figure 4. CR / VGPR Rate Increases Over Time a TN R / R Total AEs leading to treatment discontinuation 3 (12.5) 7 (13.2) 10 (13.0) SUMMARY Characteristic (n=24) (n=53) (N=77) b 1.0 Relapsed/Refractory AEs leading to death 0 (0) 5 (9.4) 5 (6.5) METHODS Age Treatment-Naïve Data cutoff: January 29, 2020. Long‑term treatment with zanubrutinib was generally well All Patients Note: Richter transformation reported as AE and PD (unrelated). • Median (range), y 65 (40‑87) 68 (45‑87) 67 (40‑87) AE, adverse event; R / R, relapsed / refractory; TN, treatment naïve. aAbdominal sepsis (Gr 5), septic arthritis (Gr 5), worsening bronchiectasis (Gr 5), gastric adenocarcinoma (Gr 5), Scedosporium infection (Gr 5), prostate adenocarcinoma, metastatic neuroendocrine tolerated and resulted in deep and durable responses >75 years, n (%) 3 (12.5) 13 (24.5) 16 (20.8) b • AU‑003 is a first‑in‑human, open‑label, multicenter, phase 1 / 2 study of 0.8 carcinoma, acute myeloid leukemia, purpura, and breast cancer (each n=1). Abdominal sepsis, septic arthritis, worsening bronchiectasis, gastric adenocarcinoma, Scedosporium infection (subset of zanubrutinib in patients with B‑cell malignancies (Figure 1) Male, n (%) 16 (67) 45 (85) 61 (79) AEs leading to treatment discontinuation). • Deep responses were observed in patients with both TN and R / R WT ECOG PS, n (%) Figure 7. Common AEs Regardless of Causality WM and in all molecular subtypes including MYD88 Figure 1. AU‑003 Study Schema 0 / 1 24 (100) 50 (94) 74 (96) 0.6 Indication-Specific Expansion Cohorts 2 0 (0) 3 (6) 3 (4) Upper respiratory tract infection With a median 35 months of follow‑up: Contusion • a Extramedullary disease, n (%) Cough – ORR of 96%, and CR / VGPR rate of 46% is excellent with the Diarrhea RP2Da Lymphadenopathy 13 (54) 26 (49) 39 (51) 0.4 DOSE ESCALATION DOSE EXPANSION Splenomegaly 9 (38) 17 (32) 26 (34) Headache rate of CR / VGPR increasing over time 320 mg qd Urinary tract infection All Dosed RP2D All Dosed No. of prior systemic therapies, median (range) NA 2 (1‑8) 2 (1‑8) Hypertension – Discontinuation due to AEs occurred in 13% of patients or Dose (WM) Pop. Dose Disease (WM) Genotype, n (%)b Constipation 160 mg bid 0.2 Fatigue – Grade 5 AEs occurred in 5 patients, none considered related MYD88L265P/CXCR4WT 14 (58.3) 26 (49.1) 40 (51.9) Cumulative Proportion With CR/VGPR With Proportion Cumulative Rash 40 mg qd 3 (1) R/R qd All B‑cell 18 (1) L265P WHIM to treatment MYD88 /CXCR4 4 (16.7) 7 (13.2) 11 (14.3) Anemia L265P UNK Back pain MYD88 /CXCR4 2 (8.3) 5 (9.4) 7 (9.1) Grade 1 – The rate of grade ≥3 atrial fibrillation was 1.3% 80 mg qd 4 (2) R/R bid All B‑cell 21 (1) MYD88WT/CXCR4WT 3 (12.5) 8 (15.1) 11 (14.3) 0.0 Neutropenia 0 3 6 9 12 15 18 21 24 27 30 33 36 39 42 Grade 2 Missing 1 (0.04) 7 (13.2) 8 (10.4) Gastroesophageal reflux disease 160 mg qd 5 (1) Non‑GCB Time From Start of Treatment, Months Nausea Grade ≥3 R/R bid 38 Pruritus DLBCL Study follow‑up, median (range), mo 28.3 (8‑44.4) 50 (4.4‑62.1) 35.3 (4.4‑62.1) No.
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