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Background: Elevated circulating growth differentiation factor 15 (GDF15) and increased GDF15 expression in tumor tissues has been observed in patients with advanced pancreatic cancer (APC). These changes were correlated with poor survival. Effects of GDF15 on tumor progression, metastasis and immune escape may play a role. NGM120, a novel antibody to GFRAL that blocks the effects of GDF15, has resulted both in antitumor and anti-cachexia effects in experimental models. Here we report updated findings of the ongoing Phase 1b study with NGM120 in patients with APC. Methods: Metastatic pancreatic cancer patients with elevated serum GDF15 were treated with NGM120 (30 or 100 mg, s.c., q4wks) in a 1st line setting in combination with Gem/nab-paclitaxel. Primary endpoints were safety and tolerability. Secondary endpoints were pharmacokinetics, preliminary evidence of antitumor activity (RECIST) and anti-cachexia effects. Results: Eight patients received NGM120 in combination with Gem/nab-paclitaxel. Median age was 67 years, all patients had advanced disease. NGM120 was well tolerated with no dose-limiting toxicities. Most of the AEs or SAEs observed were Gem/nab-paclitaxel related and none of them attributed to NGM 120 treatment. As of data cut off on March 25, 2022, preliminary results include 3 patients with PR (extending >32 wks), 3 patients SD; 2 patients discontinued early (before first post-dose scan) due to toxicity attributed to Gem/nab-paclitaxel. Among the 6 evaluable patients, the disease control rate (DCR) is 100%, mPFS has not been reached, 12-month survival rate (12-month OS) is 83.3%. Over the course of the study, 5/6 of the patients gained or maintained their body weight (BW) and 5/6 of the patients gained or maintained their lean body mass (LBM) based on maximum change from baseline. Conclusions: NGM120 given in combination with Gem/nab-paclitaxel to patients with APC resulted in a 50% ORR (3 PR in 6 evaluable patients), 100% DCR, 83.3% 12-month OS and a “not reached” mPFS. Compared to historical Gem/nab-paclitaxel data, these findings are encouraging and support the potential role of NGM120 in the treatment of patients with APC. The positive effects on BW and LBM is also encouraging compared to the historical cachexia rate of 30% observed within 12 weeks of starting first-line chemotherapy in APC. A sign of NGM120 engages the GDF15-GFRAL pathway in managing body weight regulation. A Ph2a study is ongoing to further evaluate NGM120 in combination with Gem/nab-paclitaxel in the 1st line setting for the treatment of APC. Citation Format: Andrew Hendifar, Efrat Dotan, Benjamin Weinberg, Edward Kim, Peter Hosein, Jian Luo, Jiping Zha, Alex DePaoli, Vladimir Hanes, Cecilia Tranmuchowski, Kefei Zhou, Carol Tseng, Hsiao Lieu. Initial results of a cohort of advanced pancreatic cancer patients in a phase 1b Study of NGM120, a first-in-class anti-GDNF Family Receptor Alpha Like (GFRAL) antibody [abstract]. In: Proceedings of the AACR Special Conference on Pancreatic Cancer; 2022 Sep 13-16; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2022;82(22 Suppl):Abstract nr PR006.

Pathological complete response (pCR) after neoadjuvant therapy is an accepted surrogate endpoint for breast cancer registration trials and is a strong prognostic biomarker especially in high-risk tumor biology. The LILAC study, a comparative trial for the trastuzumab biosimilar ABP 980, was the first international multicenter neoadjuvant breast cancer trial using local and central pathology review for pCR. Here we report concordance between local and central review for the most commonly used pCR definitions. This study included 725 patients with early HER2-positive breast cancer, comparing neoadjuvant ABP 980 and trastuzumab reference product (RP) in combination with anthracycline and taxane-containing chemotherapy. Equivalence of both arms was defined at a significance level of 0.05 by comparing the 2-sided 90% confidence interval (CI) for the risk difference (RD) of pCR between ABP 980 and RP within a predefined margin (-13%, 13%) using definition 2 as described below. pCR was evaluated in local laboratories and in a central laboratory blinded to the local result. The purpose of the independent, central review was to reduce the inter-pathologist variability and provide a more consistent assessment. Central review was performed by 2 independent pathologists; in cases of discordance the specimen was reviewed and decided by a third pathologist (adjudicator). The pCR definition in the primary analysis was no invasive breast cancer in breast and axillary nodes, regardless of ductal carcinoma in situ (DCIS). No invasive tumor in the breast was pCR definition 1, no invasive breast cancer in breast and axillary nodes regardless of DCIS was pCR definition 2, and no invasive breast cancer in breast and axillary nodes and absence of DCIS was pCR definition 3. The RDs and CIs were evaluated for local and central pCR review for all 3 pCR definitions. The results of the neoadjuvant LILAC study have been reported previously, demonstrating no clinically meaningful differences between ABP 980 and RP in HER2-positive early breast cancer. Of the 696 subjects who underwent surgery and had specimens evaluable for pCR review by the local pathologists, 669 specimens were available for central review. Rates of pCR in the local review were 51.1% (ABP 980) and 45% (RP) for definition 1, 48% (ABP 980) and 40.5% (RP) for definition 2, and 37.7% (ABP 980) and 29.6% (RP) for definition 3. The corresponding pCR rates in the central review were 51.3% and 47.3% for definition 1, 47.8% and 41.8% for definition 2, and 29.9% and 26.1% for definition 3. The CI for RD was within the predefined margins for pCR definition 1 in local and central review, whereas it exceeded the prespecified margin in local review for pCR definitions 2 and 3. In the central review the CI was within the margin for the pCR definitions 2 and 3, with the difference between local and central pathology review 1.6% for pCR definition 2 and 4.4% for pCR definition 3, respectively. RDs (90% CI) for all 3 pCR definitions are shown in the Table. The LILAC study demonstrated that a central pathology review for pCR is feasible in a large, international, multicenter neoadjuvant breast cancer trial. Our results show that concordance between local and central pathology can decrease with increasing complexity of the pCR definition. Based on the results, it may be justified to include a central pathology review in neoadjuvant multicenter breast cancer trials with strict pCR definitions. Citation Format: Hanz-Christian Kolberg, Marco Colleoni, Georgia Savva Demetriou, Patricia Santi, Hans Tesch, Yasuhiro Fujiwara, Vladimir Hanes. The importance of central pathology pCR review in an international multicenter neoadjuvant study in HER2 positive early breast cancer - Results of the ABP 980 LILAC trial [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr OT1-03-04.

Background Approval of biosimilars is based on the totality of evidence (TOE) supporting clinical equivalence between the proposed biosimilar and the reference product (RP). TOE comprises comprehensive studies designed to evaluate structural, functional, pharmacokinetic (PK), and clinical similarity. TOE provides scientific justification for possible extrapolation across indications that share a common mechanism of action. ABP 980 has been shown to be biosimilar to trastuzumab using robust analytical and functional assessments. Results from phase 1 and phase 3 studies have shown PK and clinical similarity to trastuzumab. Here, we extend the similarity assessment using multiple orthogonal assays for the primary mechanism of action. Methods Multiple lots of ABP 980, trastuzumab (US) and trastuzumab (EU) were compared in the biological activity assessment. In addition to the primary assessment, we conducted additional characterization assays assessing human epidermal growth factor receptor 2 (HER2) cell binding, inhibition of HER2 signaling, inhibition of HER2 ligand-independent proliferation in gastric cancer cells, and a synergy study conducted with docetaxel chemotherapy in gastric cancer cells. HER2 cell-based binding assays were performed using SKBR-3 target cells and a competitive inhibition format. Inhibition of AKT phosphorylation was assessed by comparing the effect of test samples on basal pAkt in the BT-474 breast cancer line. Inhibition of HER2 ligand-independent proliferation was assessed using the gastric cell line NCI-N87 and specificity of inhibition was evaluated using MCF-7 cells that do not have amplified HER2 expression. The synergy study was conducted using NCI-N87 gastric cancer cells and docetaxel using the Combinatorix™ method. Results Relative cell binding to HER2 was similar (ABP 980, 93%-112%; trastuzumab [EU], 98%-109%; trastuzumab [US], 96%-102%). Synergy scores (mean ± SD) with docetaxel (in NCI-N87 cells) for ABP 980, trastuzumab (US) and trastuzumab (EU), respectively, were 16.1 ± 1.4, 16.4 ± 1.8, and 15.8 ± 1.3. Functionally, ABP 980 and trastuzumab similarly inhibited HER2 ligand-independent proliferation in NCI-N87 gastric cancer cells, exhibited specificity against MCF7 non-amplified HER2 expressing breast cancer cells, and showed similar inhibition of pAkt phosphorylation in BT-474 breast cancer cells. Conclusions In this study, we show similar activity between ABP 980 and trastuzumab RP, either alone or in combination with docetaxel, in both breast cancer and gastric cancer cell lines. Our results add to the TOE supporting the biosimilarity of ABP 980 and trastuzumab, and the justification for extrapolation across its approved indications. Citation Format: Kolberg H-C, Colleoni MA, Tomasevic Z, Ponomarova O, McBride HJ, Tesch H, Hanes V. Matching the critical function of the biosimilar ABP 980 and trastuzumab: Totality of evidence and scientific justification for extrapolation across trastuzumab indications [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-17-21.

Background: Analytical, functional, and pharmacokinetic similarity between ABP 980 and trastuzumab (TRAS) has been demonstrated. Here we report results from the single switch treatment arm in the adjuvant phase of the corresponding clinical study. Methods: The objective of this randomized, multicenter, double-blind study was to compare ABP 980 with TRAS in women with HER2-positive early breast cancer. After run-in anthracycline-based chemotherapy, patients were randomized 1:1 to intravenous ABP 980 or TRAS plus paclitaxel Q3W for 4 cycles. Surgery (breast and sentinel node or axillary lymph node dissection) was completed 3-7 weeks after the last dose of study drug. Following surgery, patients who initially received TRAS were allocated to either continue TRAS or undergo a single switch to receive ABP 980 Q3W for up to 1 year from the first dose of investigational product (IP) in the neoadjuvant phase. Allocation occurred at randomization and was maintained blinded. The objective of the single switch was to evaluate safety and immunogenicity of subjects transitioning from TRAS to ABP 980. Results: Here we report data collected at the time of the primary analysis, when all patients had completed the first post-surgery clinical visit or withdrawn from the study. The majority of patients had completed the study at the time of this analysis. Of the 827 enrolled patients, 725 were randomized (ABP 980: n=364; TRAS: n=361). Of the 361 patients randomized to TRAS in the neoadjuvant phase, 173 and 174 patients in the TRAS/TRAS and TRAS/980 arm completed surgery, respectively, and 171 patients in each group entered the adjuvant phase following surgery. A total of 89 (52.0%) and 98 (57.3%) patients had an adverse event (AE) in the TRAS/TRAS and TRAS/980 group, respectively; 10 (5.8%) patients in each group had a grade ≥3 AE. AEs of interest are listed in Table 1. Table 1: Adverse Events of Interest TRAS/980 (n = 171)TRAS/TRAS (n = 171) Total, n (%)Grade ≥3, n (%)Total, n (%)Grade ≥3, n (%)Any AE of interest45 (26.3)5 (2.9)39 (22.8)5 (2.9)Infections and Infestations21 (12.3)2 (1.2)14 (8.2)2 (1.2)Neutropenia13 (7.6)1 (0.6)16 (9.4)2 (1.2)Infusion reactions15 (8.8)3 (1.7)10 (5.8)1 (0.6)Hypersensitivity7 (4.1)03 (1.8)0Pulmonary toxicity1 (0.6)1 (0.6)2 (1.2)1 (0.6)Cardiac failure1 (0.6)01 (0.6)0 One patient in the TRAS/980 arm developed binding, non-neutralizing anti-drug antibodies (ADAs) during the adjuvant phase, compared with 4 patients (2 each in the ABP 980 and TRAS arms) in the neoadjuvant phase. The percentage of patients with disease progression or recurrence or death was 5.3% and 2.9% in the TRAS/TRAS and TRAS/980 arm, respectively (hazard ratio for TRAS/980 vs TRAS/TRAS, 0.48; 90% CI: [0.181, 1.292]). Conclusions: Switching from TRAS to ABP 980 following surgery was safe in patients with breast cancer. Switching did not increase the frequency or severity of AEs and no unexpected safety signals were noted, and it did not increase the incidence of developing ADAs. Event-free survival was also similar between treatment groups. Citation Format: von Minckwitz G, Turdean M, Zhang N, Santi P, Hanes V. Biosimilar ABP 980 in patients with early breast cancer: Results of single switch from trastuzumab to ABP 980 [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-20-13.

Background: Analytical, functional, and pharmacokinetic similarity between the proposed biosimilar ABP 980 and trastuzumab (TRAS) has been shown. Similar efficacy and safety have also been demonstrated in the neoadjuvant phase of the phase 3 comparative clinical study. Here we focus on the safety and immunogenicity results from the adjuvant phase of this study. Methods: The objective of this study was to compare ABP 980 with TRAS in women with HER2 positive early breast cancer. After run-in anthracycline-based chemotherapy, patients were randomized 1:1 to intravenous ABP 980 or TRAS plus paclitaxel Q3W for 4 cycles. Surgery was completed 3-7 weeks after the last dose of neoadjuvant study drug. After surgery, patients who initially received TRAS were allocated to either continue TRAS (TRAS/TRAS arm) or undergo a single switch to receive ABP 980 (TRAS/980 arm) and patient who initially received ABP 980 continued to receive ABP 980 (980/980 arm) Q3W for up to 1 year. This report is based on safety data collected at the time of primary analysis, when all patients had completed the first post-surgery clinical visit or had withdrawn. The majority of patients had completed the study at the time of this analysis. Results: 725 patients were randomized; 364 and 361 patients were randomized to ABP 980 and TRAS, respectively, in the neoadjuvant phase. Following surgery, 349 patients in the 980/980 arm, 171 patients in the TRAS/TRAS arm, and 171 patients in the TRAS/980 arm entered the adjuvant phase. Adverse events (AEs) during the adjuvant phase are shown in Table 1; data from the neoadjuvant safety phase have been previously reported. Table 1 980/980 (N = 349)TRAS/TRAS (N = 171)TRAS/980 (N = 171)AE category, n (%) Any AE201 (57.6)89 (52.0)98 (57.3)Any grade ≥3 AE27 (7.7)10 (5.8)10 (5.8)Any fatal AE001 (0.6)Any serious AE14 (4.0)4 (2.3)4 (2.3)AEs of Interest, n (%) Infections and infestations46 (13.2)14 (8.2)21 (12.3)Neutropenia37 (10.6)16 (9.4)13 (7.6)Infusion reactions27 (7.7)10 (5.8)15 (8.8)Hypersensitivity11 (3.2)3 (1.8)7 (4.1)Pulmonary toxicity3 (0.9)2 (1.2)1 (0.6)Cardiac failure01 (0.6)1 (0.6)LVEF decline by ≥10% and to below 50%, n/N* (%)9/313 (2.9)3/154 (1.9)3/153 (2.0)LVEF = left ventricular ejection fraction; N* = Number of patients with data available One patient in the TRAS/980 arm developed binding antibodies during the adjuvant phase; this patient tested negative for neutralizing antibodies. In the neoadjuvant phase, 2 patients in the ABP 980 arm and 2 in the TRAS arm developed binding antibodies but tested negative for neutralizing antibodies. The percent of patients with disease progression or recurrence or death was 5.2% in the 980/980 arm, 5.3% in the TRAS/TRAS arm, and 2.9% in the TRAS/980 arm. The estimated hazard ratio from a stratified Cox proportional hazards regression model for 980/980 versus TRAS/TRAS was 1.01 (90% CI: [0.530, 1.930]) and for TRAS/980 versus TRAS/TRAS was 0.48 (90% CI: [0.181, 1.292]). Conclusions: Safety of ABP 980 is similar to TRAS in patients with HER2+ early breast cancer in both the neoadjuvant and adjuvant phases and consistent with the historical safety profile of TRAS. The immunogenicity profile of ABP 980 is low and consistent with TRAS. Citation Format: Kolberg H-C, Demetriou GS, Zhang N, Tomasevic Z, Hanes V. Safety results from a randomized, double-blind, phase 3 study of ABP 980 compared with trastuzumab in patients with breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr PD3-10.