The Lived Experience of Talquetamab Therapy in a Patient With Multiple Myeloma

In December 2009, Karen Kehl, an elementary school teacher and volleyball coach, woke up with a kink in her neck and pain in her back. Days later, she was diagnosed with multiple myeloma. Over the course of her treatment journey, which has lasted more than a decade, she has undergone various treatment regimens, received a transplant 3 times, and participated in many clinical trials.

As part of a From All Angles program hosted by CancerNetwork^®, Kehl and Binod Dhakal, MD, MS, Kehl’s treating physician and an associate professor of medicine in the Division of Hematology at the Medical College of Wisconsin, discussed her experiences going through multiple myeloma treatment and the current landscape of bispecific antibodies, such as talquetamab-tgvs (Talvey).

The Journey

Dhakal / How did you make the decision that [talquetamab] is the treatment you should go for, besides my recommendation? What are the other factors that you thought were helpful in the decision-making?

Kehl / One of the big factors is that I have to drive 1.5 hours to [Froedtert and the Medical College of Wisconsin], and with the [treatment], I have to wait 1 hour after my premedication. But after the shot, I’m ready to go home. That’s very [positive] because I don’t have to spend as much time at the hospital.

[Another factor] is [the drug’s adverse] effects. In the very beginning, I was not sure this was going to work because I was in the hospital. I had a very bad reaction the first time. I lost my breath—I always say you know how bad it is with how many people are in your room, and there were 6 or 7 people in my room. I recuperated from that and, with the second dose 1.5 days later, I had another reaction, but it was not as severe. [With] the third dose, I had no reaction. That’s why we continued. I have not had a reaction from the [treatment] since then.

Some [adverse] effects [that I’ve experienced are losing] my sense of taste and smell, and my fingernails have peeled. I went to my 50th college reunion, so I put fake nails on—that was great for that day. The [adverse] effects are well worth the effectiveness of the drug.

Dhakal / [Talquetamab] was initially studied in the [the phase 3 MonumenTAL-1 study (NCT03399799)], which led to the approval of this drug…. The response rate is quite impressive. Almost 70% of patients responded, including the patients who had seen the prior T-cell–based therapies like BCMA [B-cell maturation antigen] CAR [chimeric antigen receptor] T-cell therapies or BCMA bispecific antibodies. The responses were quite durable in patients, especially for the patients [who received 0.8 mg/kg]. The median duration of response was quite long—up to 17 months—and the progression-free survival was about 10 months. At the same time, especially for patients who achieve deep responses like complete responses and better—for example, someone like you—their responses are even longer.

As a patient, what are the other factors that you consider, especially for this drug, and what aspects were you excited about?

Kehl / I had just come off a [pomalidomide (Pomalyst)] regimen that had not worked very well. The fact that this was not a clinical trial anymore was a positive aspect for me because other people had been on this and had [positive] results from it. I am always open to new and different regimens because I have a lot of positivity in my life. I’m willing to try new things for the aspect of helping other patients [with multiple myeloma] because I’m sure there were people ahead of me who tried a lot of these clinical trials, [without whom] I would not have been able to go on them. I have lived long past my original diagnosis lifespan.

Dhakal / In your case, what was helpful for me was that you were already being treated with a BCMA bispecific antibody. That antigen was already being used, but that doesn’t mean that you could not respond. You could have still responded, but you were already being treated with that. My goal was to try a different antigen.

We had this drug we could try [that targets] the GPRC5D—[talquetamab]. If you look at the data, the patients who received this drug—especially if there [was] a long gap between the first [and second] bispecific [antibodies]—usually responded very well. You are a good example, with how you responded well and are still responding at 19 months.

One of the advantages was that we switched the target, but…we also had a long [gap] from the first bispecific antibody. Your first bispecific antibody was sometime around 2020 or 2021, so you had a big gap there. These are all factors that play a role when we offer this therapy to patients like you, including how many treatments you have had and what the [most recent] treatment you had was.

The encouraging news is that we have several bispecific antibodies that we could try, that still work…. You have 19 months [of response], but you also had a lot of lines of treatment. To see a response like that in this setting is quite remarkable.

Kehl / I also was attracted to it because it was not chemotherapy that killed all my cells. I did not have to recuperate as much because it was directed just to the [multiple myeloma] cancer cells and didn’t kill 2 million other cells in my body. The recuperation element of time is very advantageous.

Dosing

Kehl / We chose inpatient [dosing] because I had some other allergies to different medicines. I have a basic allergy to penicillin, hydrocodone, and other high-risk pain medications. We did not know my allergy reaction to this, and that’s one of the reasons we determined to do it in the hospital. The other [factor] was that I would have to…drive back and forth, [which] was not very efficient.

I have stayed at Kathy’s House, a wonderful place at Froedtert where you can stay for your long-term care, which I did for my 2 transplants. [For the other transplant], we got an apartment, but I stayed [at Kathy’s house] for 2 of my transplants. The choice was to stay in the hospital, which I was very glad for because of the allergic reaction. That was for the convenience of taking the drug there, so we decided to do it in the hospital.

Dhakal / In the initial step-up dosing, you mentioned that you had a fever and some [cytokine release syndrome], but that resolved quickly with the tocilizumab [Actemra]. You didn’t have any further episodes of those symptoms afterward.

Kehl / The respiratory [aspect] was most of the main problem. I couldn’t breathe, [so] that was their main concern. I had epinephrine that they gave me right away, [as well as] oxygen. Since then, I have had 1 bad bout of viral pneumonia and [respiratory syncytial virus] that I contracted in Seattle when I was visiting my sister, and that was very serious. From that, I have contracted an infection in my lungs, which gives me a chronic cough with phlegm. We’ve tried lots of different antibiotics [that will help] for a little while, [but] then I go right back to my yellow phlegm and respiratory problems. This is about the only thing that has been part of my daily life that has been very uncomfortable. I can take walks, but after 2 minutes, I’m out of breath and go back to a 98 oxygen level again. Exercise-induced lack of oxygen is very prevalent for me—riding bikes, swimming, and all the exercise that I love to do. That lung infection is very debilitating for me.

Dhakal / To highlight a little bit more, this [lung issue] is ongoing, even before this bispecific…. This is not a new problem that happened after this bispecific antibody. In fact, this lung problem got better because, when your myeloma was aggressive, you were looking like you had more frequent infections. Once we controlled the myeloma, the recurrent infection that you used to have is a little less [prominent]. Of course, that chronic lung issue is still there, but that recurrence has been less [prominent], and you have been more up and about.

Kehl / With my health care, I have a [registered nurse] come once a month and do a [wellness] check. She says, “You don’t even look sick, Karen. You look very good.”.... I haven’t lost my hair. I’ve lost my hair 3 times, but not with [talquetamab].

Dhakal / The other things that we want to focus on are the skin, nail, and oral toxicities. The order of the [severity of the toxicities] in the patient is the loss of taste, loss of weight, and then some dry mouth. All those are important. I always want to make sure the patient is well educated. We explained that to you very nicely before we went in. We also want to have you see a dietitian and make sure that is all taken care of. Can you describe…what that looks like and how you have been handling those toxicities?

Kehl / The loss of taste is probably the one that most affects me. It’s not pleasing [or] fun to eat when you can’t taste the food. We go out to eat, and I go, “Oh, this is delicious.” Everybody starts laughing because they know I don’t have any taste, but the texture is still there. I have not lost a major amount of weight on this. [I eat] lots of protein. I do have intestinal flu, and [I get] diarrhea when I eat a lot of roughage, salad, and different vegetables, [so] I tend not to eat a lot of those. Intermittent diarrhea is also an aspect you have to be ready for, [but] that is partly because of my 3 different large doses of chemotherapy with my transplants. I had a good month of diarrhea with those transplants. My intestines are not healthy. [That’s] probably not an effect of this drug, though; it probably was damaged way before this. That’s livable. The nails are not that problematic, and I’m leading a very good quality of life.