ASH 2024 | Outcomes of elderly patients with RRMM treated with teclistamab in the real-world setting

Hello, I’m Oren Pasvolsky. I’m a myeloma physician at the MD Anderson Cancer Center in Houston, Texas. This year’s ASH meeting, I will be presenting a study on outcomes of elderly patients who received teclistamab in the real-world setting. This was a multi-center study done on behalf of the US Myeloma Immunotherapy Consortium. So teclistamab is a first-in-class anti-BCMA bispecific antibody that has shown very promising results in the pivotal Majestic-1 study. The overall response rate was over 60% and the median progression-free survival was almost one year. Cytokine release syndrome was reported in approximately 70% of patients and mostly grade 1 or 2. Neurotoxicity was reported in approximately 15% of patients, again mostly grade 1 or 2. So when we talk about multiple myeloma, we need to remember that this is a disease of the elderly with a median age diagnosis of 69 years. With the continuing aging of the global population, it is important that new drugs in myeloma are evaluated in older patients. In the Majestic-1 study that I mentioned, only 24 patients were aged 75 years or older, and there’s very little published data regarding the use of teclistamab in the elderly population. So we conducted a large multi-center retrospective study that included 13 centers that are part of the U.S. Immunotherapy Consortium. We included patients with relapsed/refractory myeloma who received teclistamab as standard of care treatment. We divided patients into two groups. Those younger than the age of 75 and those age 75 years or older. So we had 302 patients in the younger group and 83 patients in the older group. There were some differences in baseline characteristics between the two age groups. The older age group less often had some adverse risk disease characteristics including high-risk cytogenetics having double hit myeloma and having high tumor burden in the bone marrow prior to starting teclistamab. Also, the patients in the older group less often had extramedullary disease at baseline. When we examined the safety outcomes we found that the rates of cytokine release syndrome were overall similar between the two age groups. The total rate of CRS was 51% in the older age group and 59% in the younger age group. Most events were grade one and there were no grade four events in the older age group. We found that a similar proportion of patients in both age groups received tocilizumab for the CRS at approximately 60% and also a similar proportion of patients received steroids for the CRS, approximately 30% in both age groups. Also, when we looked at the occurrence of ICANS, we found an overall similar rate of neurotoxicity events, 19% in the older age group compared to 13% in the younger age group. Most events were low grade, grade one or two, and no grade four events were observed in the older age group. A total of 118 patients died during follow-up in the younger age group and 20 patients died in the older age group. The most common cause of this in both age groups was progression of myeloma. There was a slightly higher proportion of older patients who died from infections. So again, the numbers were quite small. Most infections leading to this in both age groups were either pneumonia or sepsis. There was no significant difference in rates of early deaths between the two age groups when we examined two time points at either three or six months from the start of teclistamab. Next, we looked at the efficacy outcomes. We found that older patients actually had a trend towards higher overall response rate to teclistamab at 62% compared to 53% in the younger age group, though not reaching statistical significance. There was also a trend towards a better rate of achieving at least a very good partial response in the older age group at 53% compared to 44% in the younger patients. As far as overall survival and progression-free survival, so the unadjusted PFS was actually longer in the older age group. Median PFS was approximately five months in the younger age group and a bit more than 10 months in the older age group. Also, the median overall survival, which was just over 16 months in the younger age group, actually had not yet been reached in the older age group. However, when we did multivariable analysis, we found that age was not a significant predictor of either PFS or overall survival. So overall, we found that elderly patients who received teclistamab in the real-world setting had comparable safety and efficacy outcomes compared to those reported in the Majestic-1 study. We saw that younger patients in our study had more adverse risk baseline features and inferior survival outcomes. But this is probably related to patient selection and prescribing patterns in the early days of standard of care teclistamab. And we saw that in multivariable analysis, age did not have a significant impact on survival outcomes. The study does have some inherent limitations due to its retrospective and multicenter nature. This includes selection bias and variability in care. But I think overall, the take-home message is that this data suggests that age as of itself should not be a barrier to giving our older myeloma patients teclistamab.

This transcript is AI-generated. While we strive for accuracy, please verify this copy with the video.