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ASCO 2024 | Sequencing and the management of adverse events when administering bispecifics for myeloma
Amrita Krishnan, MD, City of Hope, Duarte, CA, discusses key considerations for community hematologists when administering bispecifics for multiple myeloma (MM). Emphasizing a preference for CAR T-cell therapy first for eligible patients, she notes that bispecifics can still be effective post-CAR-T. The main concern with BCMA-directed bispecifics is infection risk, suggesting GPRC5D-targeted bispecifics for high-risk patients. For talquetamab, managing on-target toxicities involves dose reduction and delays. This interview took place during the 2024 American Society of Clinical Oncology (ASCO) Meeting in Chicago, IL.
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Transcript
A real bias is still, if we are going to use a T-cell-directed therapy that we would do a CAR-T cell first, because you can always do a bispecific after CAR-T relapse and still get quite good responses and results. So I think that is really my message to the community is ideally you refer those patients, let a CAR-T center decide is this a CAR-T candidate or not. If not, then you would consider moving to a bispecific...
A real bias is still, if we are going to use a T-cell-directed therapy that we would do a CAR-T cell first, because you can always do a bispecific after CAR-T relapse and still get quite good responses and results. So I think that is really my message to the community is ideally you refer those patients, let a CAR-T center decide is this a CAR-T candidate or not. If not, then you would consider moving to a bispecific.
So for bispecifics I think they do have different tox profiles. So in terms of the BCMA-directed bispecific, biggest concerns have always been infections. So patients who are particularly predisposed to recurrent infections, perhaps you would look more at a GPRC-targeted bispecific. But those are really the two major differentiating points right now. I mean, you do have to think of some of the other on target toxicities of talquetamab in terms of dysgeusia, associated weight loss. So perhaps in a more frail patient, that would be also an issue that you’d have to consider. So for talquetamab, really, the data has suggested that dose reduction and dose delays are the best management strategies to manage those unique toxicities. And fortunately, we’ve also shown from the MonumenTAL subgroup analysis that you can still maintain efficacy.
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