Data Review of Teclistamab and Elranatamab in R/R MM

EP: 1.MonumenTAL-1: Outcomes From the Extended Median Follow-Up Data

EP: 2.MonumenTAL-1: Outcomes From the Extended Median Follow-Up Data (Part 2)

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EP: 3.Data Review of Teclistamab and Elranatamab in R/R MM

EP: 4.Expert Opinion on Modern Availability of Several Agents

EP: 5.Future of R/R MM: Emerging Bispecifics and Trispecifics

EP: 6.Optimal Dosing of Talquetamab

Data Review of Teclistamab and Elranatamab in R/R MM

Recent updates on BCMA-targeted bispecific antibodies teclistamab and elranatamab have reinforced their established efficacy profiles in patients with R/R MM. Both agents continue to demonstrate effectiveness with no new safety signals emerging from long-term follow-up data. The infection risk profile remains consistent with previous reports, with notable grade 5 events in the teclistamab studies attributed to COVID-19 complications during the pandemic period, highlighting the challenges of conducting clinical trials during that time frame.

Response kinetics for both agents follow predictable patterns, with patients typically achieving initial responses within 1 month and reaching deep responses by 3 to 4 months. Patients who achieve complete responses demonstrate superior outcomes compared with those with partial responses. A key advantage of these BCMA-targeted therapies is the built-in dose de-escalation strategies that allow for reduced treatment frequency based on response depth. Patients achieving partial response or better can be de-escalated from weekly to every-2-week dosing, and those maintaining responses may further reduce to every-4-week dosing, addressing important considerations around treatment burden, facility visits, and financial barriers.

Clinical practice implementation varies significantly among practitioners, with some employing response-adaptive approaches where complete responders maintaining responses for specified periods can be de-escalated to monthly or less frequent dosing. The comparison between teclistamab (11-12 months median PFS) and elranatamab (approximately 17 months) may reflect differences in patient populations and trial conduct rather than true therapeutic differences. Early bispecific experiences from 2016-2017 involved hospice-bound patients without current knowledge of infection prophylaxis, opportunistic infection monitoring, or optimal supportive care measures. Modern trials incorporate more aggressive mitigation strategies and improved supportive care protocols, making direct comparisons challenging but benefiting patient outcomes through evolved clinical practices.