Managing Dysgeusia Associated with Bispecific Antibody Treatment in MM

An expert panel discusses the management of dysgeusia associated with bispecific antibodies in treating patients with multiple myeloma.


Saad Z. Usmani, MD, MBA, FACP: In terms of the mechanism of action, it’s not well understood or studied, but that poses a therapeutic challenge. Do you treat the GI [gastrointestinal] tract, like in this case, thinking there might be something going on there? Or do you treat agents that are more central in terms of their mechanism of action? This is where Anna becomes our first line of defense because she’s actually taking those phone calls for our patients who may be having this experience. So, Anna, what is going through your mind if you’re receiving a phone call like this?

Anna Howard, RN: I think that a big thing is to make sure patients are monitoring their weight closely because nurses aren’t always taking their weight every time. So warning them ahead of time to be monitoring their weight closely and to let us know if there are any changes. Also with appetite changes, that’s not always something that is initially included in the nursing assessment. So making sure to ask patients about changes in appetite and not just specifically nausea and vomiting, because it seems like in this case, especially, the weight loss was a big component. With getting a call like this, also letting them know that we’re discovering that it’s more of an expected symptom with the BCMA [B-cell maturation antigen], to be looking out for that. And then especially notifying the MD [medical doctor] when you are getting a call like this to manage it early on and do more aggressive management from the beginning so that it doesn’t get to a point where they are significantly losing weight is definitely important instead of just monitoring for a long time.

Saad Z. Usmani, MD, MBA, FACP: And it looks like this patient was treated for presumed thrush, which can easily explain these symptoms. But one of the things that we are observing with bispecifics is other opportunistic infections, including CMV [cytomegalovirus] showing up in the gut or viremia for that matter. So as we think about the infectious causes that could be causing these symptoms in a patient, I think we have to pay attention to those as well. Very much like our elotuzumab patient population, essentially. What do you think, Michael?

Michael Scordo, MD: You took the words out of my mouth. That’s exactly right. I think we have to think a bit outside the box. Obviously, many of these folks are also heavily pretreated. They’ve had multiple lines of therapy. They’ve had transplants, some of them multiple transplants, and I think we need to consider some of these viral reactivations. In general, if somebody has viral reactivation with some sort of organ disease like colitis or arthritis, usually they have a virus in the blood that you could detect as at least an initial sign. But at times there could be discordance between what we’re seeing in the blood and the tissue. So one way to do that would be to consider, especially if somebody’s having prolonged symptoms that are maybe a bit more severe than would be considered, to do an endoscopy and actually get tissue biopsies to stain for viruses like adenovirus or CMV, etc.

Saad Z. Usmani, MD, MBA, FACP: I agree with you. This was an excellent discussion by all of you.

Transcript edited for clarity.

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