Dr Richter on Proactive Toxicity Management With Bispecific Antibodies in Myeloma

Joshua Richter, MD, associate professor of Medicine, the Division of Hematology and Medical Oncology, Tisch Cancer Institute, and director of Multiple Myeloma, Blavatnik Family Chelsea Medical Center, Mount Sinai, discusses the role of bispecific antibodies in the contemporary therapeutic arsenal for patients with relapsed/refractory multiple myeloma.

His insights, drawn from his presentation at the 41st Annual CFS^®, shed light on the integration of bispecific antibodies into the current treatment paradigm for relapsed/refractory disease, and how toxicity from these agents can be mitigated.

Focusing on BCMA-directed bispecific antibodies such as teclistamab-cqyv (Tecvayli) and talquetamab-tgvs (Talvey), Richter emphasizes the advantages of prophylactic measures to manage potential treatment-related toxicities.

Richter discussed recommending prophylaxis against Pneumocystis jirovecii pneumonia, using agents such as trimethoprim sulfamethoxazole or atovaquone for patients undergoing BCMA-targeted bispecific antibody therapy. Similarly, Richter advises herpes simplex virus/varicella zoster virus prophylaxis with either acyclovir or valacyclovir. Stressing the importance of maintaining immunocompetence, he advocates for primary prophylaxis with intravenous immunoglobulin (IViG) in patients treated with BCMA-based bispecific antibodies. He acknowledges the need for a nuanced approach, suggesting delayed initiation of IViG due to initial high immunoglobulin G (IgG) levels in patients with relapsed disease to mitigate the risk of hyperviscosity, with subsequent administration recommended after IgG levels stabilize.

Furthermore, Richter discusses strategies to address toxicity associated with anti-CD38 antibodies, proposing secondary prophylaxis with IViG upon the onset of hypogammaglobulinemia and recurrent infections. This adaptive strategy ensures timely intervention while minimizing adverse effects, he says.

Richter's insights underscore the importance of proactive toxicity management in the context of bispecific antibody therapy for patients with multiple myeloma. By implementing targeted prophylactic measures, clinicians can optimize treatment outcomes and minimize AEs, thereby enhancing patient care and quality of life, he concludes.