Phase I study of intravesical anti-CD40 agonist antibody 2141-V11 for non-muscle invasive bladder cancer unresponsive to Bacillus Calmette-Guerin (BCG) therapy

TPS4616 Background: CD40 is an immune-stimulatory receptor centrally involved in activating antigen-presenting cells and downstream anti-tumor immunity. Multiple agonistic anti-CD40 antibodies have been investigated clinically for cancer therapy, but have thus far shown limited efficacy and notable systemic toxicity. Our group has previously demonstrated that the ability of the Fc domain of anti-CD40 agonist antibodies to engage the FcγRIIB receptor, needed for optimal CD40 crosslinking, is critical for CD40 agonist activity. We engineered a fully-human anti-CD40 agonist antibody (2141-V11) with optimized Fc binding to FcγRIIB, which demonstrates significantly enhanced CD40 agonist activity. Non-muscle invasive bladder cancer (NMIBC), which remains an area of significant unmet need, represents an attractive clinical context to pursue CD40 agonist therapy given strong enrichment of CD40 in the bladder tumor microenvironment and routine use of local intravesical delivery as a potential strategy to mitigate systemic toxicity. Our preclinical studies, including in immunocompetent orthotopic murine models of bladder cancer humanized for CD40 and Fcγ receptors, revealed that intravesical delivery of 2141-V11 induced potent and durable anti-tumor immunity in both front-line and BCG-unresponsive settings without associated systemic toxicity (Garris and Wong, et al., Sci Transl Med, 2021;13:eabd1346). These data provide rationale to investigate intravesical 2141-V11 for the treatment of BCG-unresponsive NMIBC. Methods: This is a phase 1, open-label, dose-escalation study (NCT05126472) to evaluate the safety and tolerability of intravesically-delivered 2141-V11 in patients with BCG-unresponsive NMIBC who are considered ineligible for or have elected not to undergo radical cystectomy. Key inclusion criteria include adults with high-grade NMIBC (Ta, CIS, and/or T1) of urothelial histology that is unresponsive to adequate BCG therapy per consensus 2018 FDA guidelines. The primary objectives are to evaluate the safety and tolerability of 2141-V11 and to define the maximum tolerated dose and/or recommended phase 2 dose. The secondary objectives are to characterize the pharmacokinetics and evaluate the preliminary clinical activity of 2141-V11. Exploratory objectives include assessment of biomarkers of biological activity and disease resistance, their potential associations with clinical outcome measures, and patient-reported outcomes/quality of life measures. The 2141-V11 antibody is administered intravesically once weekly for 3 doses. Depending on disease status at week 13 and week 25 evaluations, patients may be eligible for re-treatment (once weekly for 3 doses) at these time points. Dose exploration utilizes a modified continual reassessment method design. Enrollment began in November 2021 and is ongoing. Clinical trial information: NCT05126472.