Ep 3. Managing Side Effects BCMA Bispecifics and Talquetamab in Myeloma
Rohit Gosain, MD
Rahul Gosain, MD, MBA
S. Vincent Rajkumar, MD
Rafael Fonseca, MD
Beth Faiman, CNP, PhD
Key Points
- Talquetamab carries distinct oral side effects, including taste changes that can be challenging for patients to manage.
- Immunoglobulin replacement therapy should be given to all patients on BCMA–directed bispecific antibodies to reduce infection risk.
- Dose modifications, such as increasing the interval between doses, may improve tolerability without compromising efficacy.
- Data continue to support the value of prophylactic tocilizumab for preventing CRS with either talquetamab or BMCA–directed agents.
Myeloma experts Beth Faiman, CNP, PhD, of Cleveland Clinic; Rafael Fonseca, MD, of Mayo Clinic; and S. Vincent Rajkumar, MD, of Mayo Clinic, joined community oncologists, Rahul Gosain, MD, MBA, of Wilmot Cancer Institute, and Rohit Gosain, MD, of Roswell Park Comprehensive Cancer Center, to review the treatment landscape for early-line relapsed or refractory multiple myeloma. During the discussion, the doctors highlighted critical strategies for managing side effects of teclistamab and talquetamab.
Teclistamab and most other conventional bispecific antibodies used in multiple myeloma target BCMA and CD3. Generally, these agents carry a risk of CRS, neurotoxicity, cytopenias, and infections. In contrast, talquetamab is a first-in-class bispecific agent that targets GPRC5D and CD3. Due to the different cells expressing GPRC5D versus BCMA, talquetamab has a potentially lower rate of cytopenias and infections, but it is associated with distinct skin, nail, and taste side effects.
With talquetamab, taste changes are a challenging side effect for many patients that can lead to nutritional deficiencies and weight loss. Collaborating with a dietician to provide dietary support and guidance may help patients cope with taste changes and maintain adequate nutrition. Dose modifications are also a key strategy, and both dose reductions and increasing the time between doses may help manage bispecific antibody side effects without compromising remissions, said Dr. Rajkumar.
For teclistamab and other BCMA–directed bispecific antibodies, managing infection risk is more critical. The doctors agreed that ongoing immunoglobulin G replacement should be given to all patients throughout the duration of therapy. In addition, growing data support the value of prophylactic tocilizumab for managing CRS risk with both talquetamab and BCMA–directed bispecifics. Overall, given the more challenging side effects associated with talquetamab, the doctors all shared a preference to start with BCMA–directed therapy before turning to talquetamab in patients with multiple myeloma.