Dr Hashmi on Real-World Teclistamab Use in Relapsed/Refractory Multiple Myeloma

Hamza Hashmi, MD, hematologist-oncologist, Medical University of South Carolina Hollings Cancer Center, discusses findings from a real-world study of the efficacy and safety of teclistamab-cqyv (Tecvayli) in patients with relapsed/refractory multiple myeloma.

A study spotlighting the efficacy and safety of the BCMA-directed bispecific T-cell engager teclistamab in a real-world population of patients with relapsed/refractory disease was presented at the 2023 ASH Annual Meeting, Hashami says. This retrospective, multicenter analysis included 106 real-world patients who received at least 1 full dose of teclistamab for relapsed/refractory disease as of July 15, 2023. Many of these patients were elderly and frail with high-risk disease biology, Hashmi notes. Furthermore, several patients had high-risk cytogenetics and/or extramedullary disease, both of which are markers of aggressive disease biology in multiple myeloma, Hashmi explains. Because of these characteristics, 83% of the patients included in this real-world analysis would have been ineligible for enrollment in the phase 2 MajesTEC-1 trial (NCT04557098). Findings from the MajesTEC-1 trial supported the 2022 FDA approval of teclistamab for patients with relapsed/refractory multiple myeloma who have received 4 or more prior lines of therapy.

The safety profile of teclistamab in this real-world population was similar to that of the agent in MajesTEC-1, Hashmi notes. However, the agent’s efficacy was slightly inferior in this analysis vs in the pivotal trial, Hashmi emphasizes. The decreased efficacy of this agent in a real-world setting was largely influenced by patient characteristics and disease features. Many real-world patients were heavily pretreated, had high-risk disease features, and were refractory to prior BCMA-targeted agents, according to Hashmi.

Overall, this study demonstrated that teclistamab is a safe treatment option for patients with relapsed/refractory multiple myeloma who have received prior CAR T-cell therapy, even if they do not meet the MajesTEC-1 enrollment criteria, Hashmi says. However, the inferior efficacy of teclistamab in this real-world population emphasizes the need for more effective treatment options for patients who have received prior BCMA-directed therapy, Hashmi concludes.