Dr Grajales-Cruz on the Safety of Teclistamab in Multiple Myeloma

Ariel F. Grajales-Cruz, MD, assistant member, Myeloma Section, Department of Malignant Hematology, Moffitt Cancer Center, discusses a retrospective analysis on real-world efficacy with teclistamab-cqyv (Tecvayli) in patients with relapsed/refractory multiple myeloma following BCMA-directed therapy. 

In the data that were presented, no new safety concerns emerged, Grajales-Cruz begins. As anticipated, some patients experienced cytokine release syndrome (CRS), although no instances of CRS exceeded grade 2 severity, and no instances of grade 3 or 4 CRS were observed. The incidence of CRS was lower in the real-world population compared with that in the clinical trial population, which was promising, according to Grajales-Cruz. Similar observations were noted regarding neurotoxicity rates, with fewer occurrences reported in the real-world analysis than in the pivotal MajesTEC-1 trial (NCT04557098). The observed toxicities in the real-world population were largely within expected parameters, he elucidates.

Infections remain a significant concern, particularly given the hypogammaglobulinemic state of these patients, he says. The consideration of intravenous immunoglobulin, prophylactic medications, and antivirals, especially in patients receiving teclistamab, is crucial, particularly for those with a CD4 count below 200 cells/mm3. Such patients are at increased risk of opportunistic infections, necessitating the consideration of prophylactic measures, such as pentamidine, to mitigate the risk of pneumonia, Grajales-Cruz explains. 

A key unanswered question pertains to treatment sequencing. The optimal sequence of therapies for patients with relapsed/refractory multiple myeloma remains elusive, particularly considering the variable responses observed in patients who have received prior BCMA-directed therapy, Grajales-Cruz expands. Although responses to CAR T-cell therapy may differ in such cases, the reverse sequence appears less impactful, he notes.

Despite this, encouraging results and responses have been noted with teclistamab in patient populations previously treated with BCMA-directed therapy, Grajales-Cruz continues. However, with the emergence of additional therapies, such aselranatamab-bcmm (Elrexfio) and talquetamab-tgvs (Talvey), the sequencing of these treatments becomes paramount. Determining the optimal sequence will be essential for achieving prolonged progression-free survival and overall survival in this patient population, he states. Although myeloma remains incurable, the expanding array of treatment options underscores its increasing manageability. Addressing the sequencing of therapies will be a pivotal focus in the coming years, Grajales-Cruz concludes.