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<h3>Background</h3> OX40 is a co-stimulatory receptor enriched on immune cells in the tumor microenvironment. OX40 agonism promotes anti-tumor responses, both singly and in combination with checkpoint inhibitors. The cognate OX40 ligand, OX40L, is a trimeric protein that activates robust signaling through clustering. INBRX-106 is a novel hexavalent OX40 agonist that has been rationally designed to optimize target clustering and provide superior agonism to previously explored bivalent entities, leading to more potent anti-tumor activity. <h3>Methods</h3> INBRX-106 is a homodimer, each half comprising three identical humanized, camelid single-domain antibody binding domains targeting OX40 linked end-to-end, and fused to an effector-enabled human IgG1 constant domain (Fc). Due to lack of rodent cross-reactivity, a valency, affinity and activity-matched murine surrogate, Hex-C04, was generated for the purpose of preclinical modeling. Hex-C04 contains an mIgG2a effector enabled Fc, the mouse isotype most analogous to the activity of human IgG1. The activity and potency of INBRX-106 and Hex-C04 were evaluated in functional in vitro T-cell assays, and the anti-tumor efficacy of Hex-C04 was evaluated alone or in combination with PD-1 blockade across a number of syngeneic tumor models. <h3>Results</h3> INBRX-106 binds specifically to OX40 with a sub nanomolar apparent affinity, without blocking the binding of its ligand OX40L. In vitro, cross-linking by INBRX-106 rapidly induces loss of OX40 surface expression in addition to driving receptor signaling. In primary T-cell assays, INBRX-106 is more potent than a bivalent comparator antibody, inducing greater upregulation of activation markers, cytokine production and proliferation. This costimulatory activity exhibits a bell-shaped dose-response curve, with maximal activity occurring at receptor occupancies of 30–100%. In vivo, tumor growth control by Hex-C04 also follows a bell-shaped dose response curve. Rapid loss of OX40 is observed in vivo as well, with both the degree and duration of OX40 loss dependent on Cmax and exposure. Hex-C04 demonstrated strong single-agent activity across a variety of preclinical tumor models including models that do not respond to a PD-1/PD-L1 checkpoint inhibitor, and this activity was improved in combination with a PD-1 blocking antibody. <h3>Conclusions</h3> Preclinically, INBRX-106 significantly outperforms bivalent antibodies in co-stimulatory capacity and anti-tumor activity. On the weight of this data, Inhibrx Inc. has initiated a first-in-human Phase 1 trial of INBRX-106 as a single agent or in combination with Keytruda® (pembrolizumab). The complex relationship between dose, OX40 target modulation and activity indicate the importance of integrating preclinical data sets with emerging clinical data to make informed decisions regarding INBRX-106 dose and schedule. <h3>Trial Registration</h3> NCT04198766 <h3>Ethics Approval</h3> The care and use of all animals were reviewed and approved by the IACUC committees of Explora BioLabs and Molecular Diagnostic Services and conducted in accordance with AAALAC regulations.