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ASCO 2025 | Prophylactic interventions for mitigating oral toxicities of talquetamab in myeloma: TALISMAN trial
Rakesh Popat, MBBS, MRCP, FRCPath, PhD, University College London Hospitals, London, UK, discusses the TALISMAN study (NCT06500884), a trial evaluating prophylactic interventions for mitigating the oral toxicities associated with talquetamab treatment in patients with relapsed/refractory (R/R) multiple myeloma (MM). TALISMAN is investigating dexamethasone mouthwash, clonazepam, and pregabalin; however, Dr Popat highlights that artificial saliva and zinc are also being considered as potential strategies for managing oral toxicities. This interview took place at the 30th Congress of the European Hematology Association (EHA) in Milan, Italy.
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Transcript
Talquetamab is a highly effective bispecific antibody which is approved for patients with relapsed/refractory myeloma. However, the GPRC5D off-tumor targeting does result in oral toxicities, namely dry mouth, dysgeusia, glossitis, and dysphagia. And these can impact upon the quality of life of patients. So it’s very important to try and understand how we can overcome these...
Talquetamab is a highly effective bispecific antibody which is approved for patients with relapsed/refractory myeloma. However, the GPRC5D off-tumor targeting does result in oral toxicities, namely dry mouth, dysgeusia, glossitis, and dysphagia. And these can impact upon the quality of life of patients. So it’s very important to try and understand how we can overcome these.
We’re trying to understand that through the TALISMAN clinical trial, which is a Phase II clinical trial investigating various different prophylactic interventions to try and improve the oral toxicities. So in this clinical trial, patients with relapsed myeloma will be randomized to either have no prophylactic interventions or to receive a dexamethasone mouthwash, which will be commenced seven days prior to the onset of talquetamab. They could receive clonazepam, which interferes with the signaling pathway and also pregabalin, which also is a neuropathic agent and can in some cases be associated with improvements in taste and other toxicities.
There are various other oral interventions that people do. This may involve artificial saliva, some people use various different mouthwashes, what someone told me about a magic mouthwash which may be useful and some institutions are recommending the use of zinc. We’re not sure if any of these are effective and so it’s really important in this clinical trial that we can prospectively understand these compared to no intervention whatsoever. So we look forward to reporting the results in the future.
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