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Fixed vs. Continuous Teclistamab
Do you want fixed or continuous teclistamab treatment in myeloma? Your oncologist may prescribe continuous administration because that is what the FDA approved.
To be clear, teclistamab buys more time for the MM survivor who has previously undergone a lot of therapy. But that’s the reason for this post.
All of the previous toxicity that MM survivors may undergo before they are prescribed teclistamab can exhaust their immune systems exposing them to increased risks of infection. So the choice of fixed vs. continuous teclistamam is as much about killing MM as it is about killing the patient’s t-cells.
In addition to the question of fixed vs. continuous teclistamab is the question of total dosing, which is discussed by Dr. Durie in the video below.
How frequently should TECVAYLI (teclistamab) be given to myeloma patients?
I am a long-term MM survivor and MM cancer coach. In my experience, maintaining immune health is as important to the MM survivor as killing their MM.
I encourage MM survivors to employ evidence-based, non-conventional complementary therapies to enhance their immune health before, during, and after conventional MM therapies.
Scroll down the page and post a question or a comment if you have about teclistamab or MM in general.
thanks,
David Emerson
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
Teclistamab Dosing Strategies in Relapsed/Refractory Myeloma: A Real-World Comparison of Weekly and Biweekly Versus Fixed Intervals
Simple Summary
Patients with multiple myeloma who relapse after several treatments often receive a new immune-based therapy called teclistamab. This drug is usually given continuously until the disease worsens or side effects become intolerable.
However, long-term treatment can:
- increase infection risk,
- lower blood counts,
- and reduce the quality of life.
In real-world practice, doctors sometimes stop treatment after patients achieve a deep and stable response, but this approach has not been formally studied. In this study, we compared patients who continued treatment with teclistamab to those who stopped after responding well. We found that stopping treatment in carefully selected patients did not shorten survival or increase the risk of relapse in the first year.
However, infections remained common, even after stopping treatment. These results suggest that fixed-duration therapy may be safe for some patients and should be evaluated further in clinical trials…
Conclusions
In this real-world analysis, both continuous and fixed-duration teclistamab strategies demonstrated meaningful clinical activity in patients with relapsed or refractory multiple myeloma. Continuous weekly or biweekly dosing remains the current standard, whereas fixed-duration discontinuation, when applied to patients with deep and durable responses, appears feasible and may lessen cumulative toxicity and infection burden in selected patients.
Outcomes of relapse after teclistamab therapy in multiple myeloma
Teclistamab is a first-in-class CD3xBCMA bispecific T-cell engager (TCE), approved by the FDA in October 2022 for the treatment of triple-class exposed relapsed/refractory multiple myeloma (RRMM) patients after ≥4 prior lines of therapy, a population that, prior to the advent of TCEs and CAR T-cell therapies, had a median overall survival (OS) of less than one year [1, 2].
The MajestTEC-1 trial demonstrated an overall response rate (ORR) of 63% and median progression-free survival (PFS) and OS of 11.3 and 18.3 months, respectively. However, despite high rates of deep initial responses, most patients relapse, and no standard of care has been established following teclistamab failure. In this study, we report the outcomes of relapse after teclistamab therapy.
We retrospectively analyzed 179 consecutive patients who completed step-up dosing and received at least one full dose of teclistamab at the University of Pennsylvania. All were triple-class exposed RRMM. Nine (5%) received 1 full dose, 10 (6%) received 2, 7 (4%) received 3, and 153 (85%) received ≥4 doses. Patients were treated either in clinical trials (n = 55; first dose: Dec 2018–Dec 2023) or commercially (n = 122; first dose: Dec 2022–Apr 2024) (Fig. 1a). Data cutoff was February 15th, 2025, with a median follow-up of 21.3 (95% CI: 19.5–24.9) months from teclistamab initiation. The International Myeloma Working Group (IMWG) criteria were used for response assessment [3] and risk stratification [4]…
fixed or continuous teclistamab