Teclistamab Vs Talquetamab After Relapse on CAR T-Cell Therapy in Multiple Myeloma

Ralph V. Boccia, MD, FACP, founder of The Center for Cancer and Blood Disorders, clinical associate professor at MedStar Georgetown University Hospital, and medical director of the International Oncology Network Clinical Research Program, outlined how he selects a bispecific antibody for patients with multiple myeloma who experience relapse after second-line chimeric antigen receptor (CAR) T-cell therapy, weighing teclistamab-tcyv (Tecvayli) against talquetamab-tgvs (Talvey). Boccia explained that the interval since CAR T-cell therapy plays a central role, as patients who relapse 6 months or more after treatment have had time for T-cell recovery, and he tends to use teclistamab in that group. Although measuring soluble B-cell maturation antigen (BCMA) can help, he noted that most community practices lack access to that test. Because talquetamab carries taste, nail, and skin toxicities that can lead to weight loss, he generally reserves it for later use or for patients previously treated with teclistamab. For patients with a large extramedullary disease burden, he turns to the combination of teclistamab and talquetamab, which was evaluated in the phase 2 RedirecTT-1 trial (NCT04586426).¹

Transcript

There’s a difference in the adverse event profile between teclistamab and talquetamab. The length of time since the patient had their CAR T helps me quite a bit. Some people can now measure soluble BCMA, and that’s also very helpful if you can do that. Most of us don’t, and most in the community won’t have that access. For patients who relapsed 6 months or more after CAR T, there’s plenty of time for those T cells to rejuvenate and grow back. I tend to use teclistamab in that population, and for those who relapse sooner or who have already had teclistamab, I would then go to talquetamab. Between the taste changes and the nail and skin changes, which result in weight loss and other less favorable effects, I tend to save talquetamab for later. If it’s a patient who has a fairly large extramedullary plasmacytoma burden, I will go to the combination [of teclistamab and talquetamab].¹

Reference

Kumar S, Mateos MV, Ye JC, et al. Dual targeting of extramedullary myeloma with talquetamab and teclistamab. N Engl J Med. 2026;394(1):51-61. doi:10.1056/NEJMoa2514752