Choosing and Implementing Bispecifics: Target Selection, CRS/ICANS Management, and Talquetamab Oral Toxicities

This segment explores practical considerations for selecting and implementing bispecific antibodies in multiple myeloma care. Faculty discuss how clinicians compare available agents based on target (BCMA vs GPRC5D), dosing schedules, step-up protocols, and overall feasibility across academic and community practice settings. Factors such as caregiver availability, travel distance, and decisions regarding inpatient versus outpatient step-up dosing are highlighted as important considerations when determining which therapies may be most feasible in routine practice.

The conversation then turns to the management of treatment-related toxicities, including cytokine release syndrome (CRS) and immune effector cell–associated neurotoxicity syndrome (ICANS). Faculty review current approaches to monitoring and managing these events, including the use of steroids and emerging strategies such as prophylactic tocilizumab to reduce CRS risk while maintaining therapeutic efficacy.

The segment also examines the unique oral and taste-related toxicities associated with talquetamab, including their impact on nutrition, weight, and quality of life. Panelists discuss strategies for monitoring and mitigation, such as early nutrition consultation, close weight monitoring, and dose adjustments when needed. Overall, the segment highlights practical approaches to safely integrating bispecific antibodies into clinical care.