SARCLISA Concentrate solution for injection Ref.[10339] Active ingredients: Isatuximab

In multiple myeloma patients treated with SARCLISA combined with pomalidomide and dexamethasone, a decrease in absolute counts of total NK cells (including inflammatory CD16 ^{+ low} CD56 ^{+ bright} and cytotoxic CD16 ^{+ bright} CD56 ^{+ dim} NK cells) and CD19 ⁺ B cells was observed in peripheral blood.

Cardiac Electrophysiology

Up to 2 times the approved recommended dose, SARCLISA does not prolong the QT interval to any clinically relevant extent.

A relationship between isatuximab-irfc exposure and overall response rate and progression-free survival was observed.

No apparent relationship was observed between an increase of isatuximab-irfc exposure and adverse reactions.

Following the administration of isatuximab-irfc at the recommended dose and schedule, the steady state isatuximab-irfc mean (CV ) predicted maximum plasma concentration (C_max) was 351 µg/mL (36.0) and area under the plasma concentration-time curve (AUC) was 72,600 µg∙h/mL (51.7%). The median time to reach steady state of isatuximab-irfc was 8 weeks with a 3.1-fold accumulation.

Isatuximab-irfc AUC increases in a greater than dose proportional manner over a dosage range from 1 mg/kg to 20 mg/kg (0.1 to 2 times the approved recommended dosage) every 2 weeks. Isatuximab-irfc AUC increases proportionally over a dosage range from 5 mg/kg to 20 mg/kg (0.5 to 2 times the approved recommended dosage) every week for 4 weeks followed by every 2 weeks.

Distribution

The mean (CV ) predicted total volume of distribution of isatuximab-irfc is of 8.13 L (26.2).

Metabolism

Isatuximab-irfc is expected to be metabolized into small peptides by catabolic pathways.

Elimination

Isatuximab-irfc total clearance decreased with increasing dose and with multiple doses. At steady state, the near elimination (≥99%) of isatuximab-irfc from plasma after the last dose is predicted to occur in approximately 2 months. The elimination of isatuximab-irfc was similar when given as a single agent or as combination therapy.

Specific Populations

Isatuximab-irfc exposure (AUC) at steady state decreases with increasing body weight. The following factors have no clinically meaningful effect on the exposure of isatuximab-irfc: age (36 to 85 years, 70 patients were >75 years old), sex, race (Caucasian, Black, Asian), renal impairment (eGFR <90 mL/min/1.73 m²), and mild hepatic impairment (total bilirubin 1 to 1.5 times upper limit of normal [ULN] or aspartate amino transferase [AST] > ULN). The effect of moderate (total bilirubin >1.5 times to 3 times ULN and any AST) and severe (total bilirubin >3 times ULN and any AST) hepatic impairment on isatuximab-irfc pharmacokinetics is unknown.

No dose adjustments are recommended in these specific patient populations.

Carcinogenicity and genotoxicity studies have not been conducted with isatuximab-irfc. Fertility studies have not been conducted with isatuximab-irfc.

ICARIA-MM

The efficacy and safety of SARCLISA in combination with pomalidomide and low-dose dexamethasone (Isa-Pd) were evaluated in ICARIA-MM (NCT02990338), a multicenter, multinational, randomized, open-label, 2-arm, phase 3 study in patients with relapsed and refractory multiple myeloma. Patients had received at least two prior therapies including lenalidomide and a proteasome inhibitor.

A total of 307 patients were randomized in a 1:1 ratio to receive either SARCLISA in combination with pomalidomide and low-dose dexamethasone (Isa-Pd, 154 patients) or pomalidomide and low-dose dexamethasone (Pd, 153 patients). Treatment was administered in both groups in 28-day cycles until disease progression or unacceptable toxicity. SARCLISA 10 mg/kg was administered as an intravenous infusion weekly in the first cycle and every two weeks thereafter. Pomalidomide 4 mg was taken orally once daily from day 1 to day 21 of each 28-day cycle. Low-dose dexamethasone (orally or intravenously) 40 mg (20 mg for patients ≥75 years of age) was given on days 1, 8, 15, and 22 for each 28-day cycle.

Overall, demographic and disease characteristics at baseline were similar between the two treatment groups. The median patient age was 67 years (range 36–86), 20% of patients were ≥75 years; 10% of patients entered the study with a history of COPD or asthma. The proportion of patients with renal impairment (creatinine clearance <60 mL/min/1.73 m2) was 34%. The International Staging System (ISS) stage at study entry was I in 37%, II in 36% and III in 25% of patients. Overall, 20% of patients had high-risk chromosomal abnormalities at study entry; del(17p), t(4;14) and t(14;16) were present in 12%, 8% and 2% of patients, respectively.

The median number of prior lines of therapy was 3 (range 2–11). All patients received a prior proteasome inhibitor, all patients received prior lenalidomide, and 56% of patients received prior stem cell transplantation; the majority of patients (93%) were refractory to lenalidomide, 76% to a proteasome inhibitor, and 73% to both an immunomodulator and a proteasome inhibitor.

The median duration of treatment was 41 weeks for Isa-Pd group compared to 24 weeks for Pd group.

The efficacy of SARCLISA was based upon progression-free survival (PFS). PFS results were assessed by an Independent Response Committee based on central laboratory data for M-protein and central radiologic imaging review using the International Myeloma Working Group (IMWG) criteria. The improvement in PFS represented a 40% reduction in the risk of disease progression or death in patients treated with Isa-Pd.

Efficacy results are presented in Table 5 and Kaplan-Meier curve for PFS is provided in Figure 1.

Table 5. Efficacy of SARCLISA in Combination with Pomalidomide and Low-Dose Dexamethasone versus Pomalidomide and Dexamethasone in the Treatment of Multiple Myeloma (ICARIA-MM):

* Stratified on age (<75 years versus ≥75 years) and number of previous lines of therapy (2 or 3 vs >3) according to IRT.
^† sCR, CR, VGPR and PR were evaluated by the IRC using the IMWG response criteria.
^‡ Estimated using Clopper-Pearson method.

The median time to first response in responders was 35 days in Isa-Pd group versus 58 days in Pd group. The median duration of response was 13.3 months (95% CI: 10.6-NR) in the Isa-Pd group versus 11.1 months (95% CI: 8.5-NR) in the Pd group. Median overall survival was not reached for either treatment group. At a median follow-up time of 11.6 months, 43 (27.9%) patients on Isa-Pd and 56 (36.6%) patients on Pd had died. The OS results at interim analysis did not reach statistical significance.

Figure 1. Kaplan-Meier Curves of PFS – ITT Population – ICARIA-MM (assessment by the IRC):