Developing a System-Wide Protocol for Talquetamab Toxicity Management

Samantha Shenoy, NP, MSN, developed a comprehensive toxicity management protocol based on 5 years of clinical experience with patients on talquetamab, beginning with clinical trial participants. The protocol evolved through consultation with dermatologists, dietitians, colleagues at other institutions, and direct patient feedback about effective management strategies. This collaborative approach resulted in a 3- to 4-page handout covering taste changes, dry mouth, skin changes, nail changes, and weight loss management.

The handout provides practical, actionable recommendations organized by toxicity type, including specific product recommendations for managing each adverse effect category. For skin toxicities, recommendations include using emollients, ammonium lactate cream, and topical steroids for palmar-plantar peeling, along with lukewarm showers and immediate post-shower moisturizing. Nail care strategies involve nail hardeners, vitamin E cuticle oil, protective coverings such as finger cots, and trauma prevention through proper footwear and activity modifications.

The proactive distribution of educational materials before treatment initiation empowers patients to prepare by purchasing recommended products and understanding what to expect during therapy. The protocol emphasizes patient empowerment through preparation, suggesting patients keep materials accessible for ongoing reference rather than attempting to absorb all information at once. This systematic approach to toxicity management represents a scalable model for other institutions implementing bispecific antibody programs.