Teclistamab Reviewed as Potential Treatment Option in Relapsed/Refractory Multiple Myeloma

CancerNetwork hosted a Training Academy focused on sequencing therapies for patients with multiple myeloma who are treated with bispecific antibodies.

Available Treatment Options

• For patients who relapse, several treatment options are available in the realm of:
  • Proteasome inhibitors
  • Bortezomib (Velcade) or carfilzomib (Kyprolis)
  • Immunomodulatory drugs
  • Lenalidomide (Revlimid), pomalidomide (Pomalyst), or daratumumab (Darzalex)
  • Other CD38 antibodies
• For patients who relapse late, treatment options include chimeric antigen (CAR) T-cell therapies such as:
• Idecabtagene vicleucel (Abecma) or ciltacabtagene autoleucel (Carvykti)

Teclistamab in Relapsed/Refractory Multiple Myeloma

• It was recently approved in the United States under the same indication as CAR T-cell therapy.1
• The trial that led to the approval was the phase 1/2 MajesTEC-1 trial (NCT03145181; NCT04557098).2
• The risk of cytokine release syndrome (CRS) is prevalent during the first few doses, and step-up dosing should be given.
• Patients should be hospitalized when teclistamab is given initially to monitor for adverse effects (AEs).
• The treatment is given subcutaneously but also indefinitely, which can increase the chance of developing long-term AEs.

AE Management

• For CRS, tocilizumab (Actemra) can be given to mitigate the AEs. However, most institutions or centers will hold off on tocilizumab if CRS is grade 1 and will observe the patient’s response before immediately treating.
  • Some will start treatment when a fever becomes present to stop it from progressing and allow more hospital beds to become available, as teclistamab must be given in an inpatient setting.

Looking Forward

• Elranatamab (Elrexfio) was evaluated in the phase 1 MAGNETISMM-1 trial (NCT03269136), in which observed that 53% of patients who were given prior BCMA therapy responded to treatment.3
• ABBV-383 antibody and linvoseltamab have shown similar efficacy for the indicated population.
• Experts hope to keep studying these treatments in earlier lines of therapy to see whether higher responses can be reached.

References

1. FDA approves teclistamab-cqyv for relapsed or refractory multiple myeloma. News release. FDA. October 25, 2022. Accessed August 24, 2023. https://bit.ly/3Fgsi4s
2. Moreau P, Garfall AL, van de Donk NWCJ, et al. Teclistamab in relapsed or refractory multiple myeloma. N Engl J Med. 2022;387(6):495-505. doi:10.1056/NEJMoa2203478
3. Raje N, Bahlis NJ, Costello C, et al. Elranatamab, a BCMA targeted T-cell engaging bispecific antibody, induces durable clinical and molecular responses for patients with relapsed or refractory multiple myeloma. Blood. 2022;140(suppl 1):388-390. doi:10.1182/blood-2022-166494