Role of Talquetamab as Bridging Therapy for CAR T-Cell Therapy

EP: 1.Late-Line R/R: Treatment Landscape

EP: 2.Outcomes and Factors for Consideration When Choosing Between CAR T Therapies

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EP: 3.Role of Talquetamab as Bridging Therapy for CAR T-Cell Therapy

EP: 4.Optimal Sequencing Strategies for CAR T and Bispecifics in R/R MM

This segment focuses on an emerging real-world practice—using the bispecific antibody, talquetamab, as a bridging therapy before CAR T-cell treatment in patients with rapidly progressing, late-line multiple myeloma. The panel agrees that reducing disease burden prior to CAR T infusion improves both efficacy and safety, particularly by lowering the risk of delayed neurotoxicity. Talquetamab, which targets GPRC5D rather than B-cell maturation antigen, has shown to be an effective option for disease control without interfering with CAR T activity. Though initially adopted without clinical trial data, real-world use has demonstrated remarkable responses, making it a promising tool for clinicians.

Clinicians report that talquetamab can significantly lower tumor burden—even reducing bone marrow plasma cell percentages from over 90% to nearly zero within a few doses. However, they also caution about unique toxicities. Because its target is expressed in skin, mucosa, and nails, patients may experience issues like taste changes, difficulty swallowing, weight loss, and skin abnormalities. These effects can be substantial enough to require delaying CAR T infusion but are usually reversible over time. Despite this, most clinicians find that the benefits of talquetamab—especially when used in patients with high tumor burden—outweigh the risks.

The consensus among the panel is that talquetamab has become a valuable real-world strategy to enhance the outcomes of CAR T therapy in difficult-to-treat patients. This practice exemplifies how real-world data can drive innovation ahead of formal clinical trials. Rather than waiting for trial-based guidelines, practitioners used shared experiences and collaborative data to pioneer this approach. The positive outcomes and manageable toxicity profile have led to broader adoption, with talquetamab now commonly used to optimize disease status before CAR T infusion, particularly in the late-line setting where it is FDA approved.