Talquetamab plus teclistamab in myeloma patients who are heavily pretreated offers a treatment option for MM patients running out of choices.
While the study linked below mentions the occurrence of side effects in general terms, the list below is more specific.
What are the possible adverse events for myeloma patients undergoing talquetamab plus teclistamab?
Cytokine Release Syndrome (CRS):
- Frequency: Common, especially after the first doses.
- Symptoms: Fever, chills, hypotension, tachycardia, hypoxia, fatigue, or organ dysfunction.
- Management: CRS is typically managed with supportive care, such as antipyretics, fluids, oxygen, and tocilizumab (IL-6 inhibitor).
Infections:
- Risk: Increased due to immunosuppression.
- Types: Bacterial, viral (e.g., herpes zoster), and fungal infections.
- Prophylaxis: Antiviral, antibacterial, and antifungal prophylaxis may be recommended.
Hematologic Toxicities:
- Common: Neutropenia, anemia, thrombocytopenia.
- Management: Growth factor support (e.g., G-CSF for neutropenia), transfusions, or dose modifications.
Hypogammaglobulinemia:
- Cause: Depletion of normal plasma cells.
- Management: Intravenous immunoglobulin (IVIG) replacement may be needed.
Skin and Nail Toxicities (specific to Talquetamab):
- Symptoms: Rash, nail changes, and paronychia.
- Management: Topical or systemic corticosteroids, antihistamines, and supportive skin care.
Dysgeusia and Oral Toxicities:
- Symptoms: Altered taste, dry mouth, and mucositis.
- Management: Oral rinses, hydration, and dietary modifications.
Peripheral Neuropathy:
- Symptoms: Tingling or numbness, usually mild.
- Management: Symptomatic treatment with pain relievers or dose adjustments.
Musculoskeletal Pain:
- Symptoms: Joint or muscle pain.
- Management: Analgesics and physical therapy.
Gastrointestinal Symptoms:
- Common: Nausea, diarrhea, decreased appetite.
- Management: Antiemetics, antidiarrheals, and dietary adjustments.
Other Immune-Related Toxicities:
- Includes elevated liver enzymes and autoimmune phenomena, which require careful monitoring and management.
Monitoring and Precautions:
- Baseline Assessment: Comprehensive evaluation of organ function and infection risks.
- Monitoring: Regular blood counts, liver function tests, and infection surveillance.
- Premedication: Steroids, antihistamines, and acetaminophen to prevent infusion-related reactions.
I understand that heavily pretreated MM patients will do most anything to put their incurable blood cancer into remission- even for a short time.
I am writing this post simply to try to make MM patients aware of the probable side effects of talquetamab plus teclistamab therapy. I live with a host of treatment-related side effects and wouldn’t wish the feeling on anyone.
Email me at David.PeopleBeatingCancer@gmail.com with questions or your experiences about talquetamab plus teclistamab therapy.
David Emerson
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
“BACKGROUND-Talquetamab (anti–G protein–coupled receptor family C group 5 member D) and teclistamab (anti–B-cell maturation antigen) are bispecific antibodies that activate T cells by targeting CD3 and that have been approved for the treatment of triple-class–exposed relapsed or refractory multiple myeloma.
METHODS-We conducted a phase 1b–2 study of talquetamab plus teclistamab in patients with relapsed or refractory multiple myeloma. In phase 1, we investigated five dose levels in a dose-escalation study. Talquetamab at a dose of 0.8 mg per kilogram of body weight plus teclistamab at a dose of 3.0 mg per kilogram every other week was selected as the recommended phase 2 regimen. The primary objective was to evaluate adverse events and dose-limiting toxic effects.
RESULTS-A total of 94 patients received treatment, with the recommended phase 2 regimen used in 44. The median follow-up was 20.3 months. Three patients had dose-limiting toxic effects (including grade 4 thrombocytopenia in 1 patient with the recommended phase 2 regimen).
Across all dose levels, the most common adverse events were:
- cytokine release syndrome,
- neutropenia,
- taste changes,
- and nonrash skin events.
Grade 3 or 4 adverse events, most commonly hematologic events, occurred in 96% of the patients.
Grade 3 or 4 infections occurred in 64% of the patients.
With the recommended phase 2 regimen, a response occurred in 80% of the patients (including in 61% of those with extramedullary disease); across all dose levels, a response occurred in 78%.
The likelihood of patients continuing in response at 18 months was 86% with the recommended phase 2 regimen (82% among those with extramedullary disease) and 77% across all dose levels.
CONCLUSIONS-The incidence of grade 3 or 4 infections with talquetamab plus teclistamab was higher than has been observed with either therapy alone.
A response was observed in a high percentage of patients across all dose levels, with durable responses with the recommended phase 2 regimen.
(Funded by Janssen Research and Development; RedirecTT-1 ClinicalTrials.gov number, NCT04586426.)…”