A Phase I Trial of the Anti-KIR Antibody IPH2101 and Lenalidomide in Patients with Relapsed/Refractory Multiple Myeloma

Abstract

PURPOSE Natural killer (NK) cells may play an important role in the immune response to multiple myeloma (MM); however, MM cells express killer immunoglobulin-like receptor (KIR) ligands to prevent NK cell cytotoxicity. Lenalidomide can expand and activate NK cells in parallel with its direct effects against MM; however, dexamethasone may impair these favorable immunomodulatory properties. IPH2101, a first-in-class anti-inhibitory KIR antibody, has acceptable safety and tolerability in MM as a single agent. The present work sought to characterize lenalidomide and IPH2101 as a novel, steroid-sparing, dual immune therapy for MM. EXPERIMENTAL DESIGN A phase I trial enrolled 15 patients in three cohorts. Lenalidomide was administered per os at 10mg on cohort 1 and 25mg on cohorts 2 and 3 days 1–21 on a 28-day cycle with IPH2101 given intravenously on day 1 of each cycle at 0.2 mg/kg on cohort 1, 1mg/kg on cohort 2, and 2mg/kg on cohort 3. No corticosteroids were utilized. The primary endpoint was safety, secondary endpoints included clinical activity, pharmacokinetics (PK) and pharmacodynamics (PD). RESULTS The biologic endpoint of full KIR occupancy was achieved across the IPH2101 dosing interval. PD and PK of IPH2101 with lenalidomide were similar to data from a prior single agent IPH2101 trial. Five serious adverse events (SAEs) were reported. Five objective responses occurred. No autoimmunity was seen. CONCLUSIONS These findings suggest that lenalidomide in combination with anti-inhibitory KIR therapy warrants further investigation in MM as a steroid-sparing, dual immune therapy. This trial was registered at www.clinicaltrials.gov (reference: NCT01217203).

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