Talquetamab Side Effects: Management and Counseling Strategies
Key Points
- Talquetamab is associated with distinct skin, nail, and oral toxicities that require dedicated management strategies.
- Changes in taste are one of the most common side effects of talquetamab, and patients should be counseled to expect some effects after starting treatment.
- Topical treatments are effective for most skin-related toxicities, although systemic steroids may be needed if rash spreads over more than 30% of the body.
While the 2026 American Society of Clinical Oncology Annual Meeting was underway, Sawyer Bawek, DO, of Cleveland Clinic, and Hamza Hashmi, MD, of Memorial Sloan Kettering Cancer Center, discussed the distinct side effect profile of talquetamab and how to manage toxicities when using it to treat patients with relapsed or refractory multiple myeloma.
Talquetamab is a bispecific T-cell engager and, like many other bispecific antibodies, is associated with risk of cytokine release syndrome (CRS) and neurotoxicity. Due to its unique GPRC5D targeting, it is also associated with distinct skin, nail, and oral toxicities.
Skin toxicities include injection site reactions, maculopapular rash, and dry, peeling skin on the hands and feet. During the first few months of treatment with talquetamab, nails may become brittle, thin, or discolored. These are usually only cosmetic effects, but oncologists should monitor for onychomycosis infections. The most challenging side effects of talquetamab are oral toxicities, including dysphagia, dry mouth, and taste changes. These toxicities, while not life-threatening, can be cumulative and heavily affect patients’ quality of life, leading to potential treatment discontinuation.
Injection site reactions and localized rash events can be treated effectively with topical antihistamines and topical corticosteroids, respectively. If patients develop more widespread rash, a short course of systemic steroids can be helpful, said Dr. Hashmi. For nail toxicities, Dr. Hashmi advises patients to keep their nails short, thin, and well-oiled, and to wear gloves when working with their hands.
Among the oral toxicities, the majority of patients will experience dysgeusia, and they should be counseled to expect some impact after starting talquetamab. The presentation can differ between patients, but food with stronger flavors may be more palatable for those experiencing dysgeusia. In addition, as a result of the oral toxicities, patients may experience weight loss. Dr. Hashmi typically refers patients to a dietitian to make sure their nutrition is not compromised.