Around the Practice: Bispecifics in R/R MM: Translating Evidence into Clinical Practice
Ajai Chari, MD; Ajay Nooka, MD, MPH, FACP; Muhamed Baljevic, MD; Gurbakhash Kaur, MD; and Anupama Kumar, MD, discuss how recent advances in multiple myeloma (MM) treatment, including quadruplet therapy regimens, CAR T-cell therapies in earlier lines, and emerging bispecific antibodies and trispecific agents, are transforming the treatment landscape with the potential to cure rather than just manage the disease, while addressing optimal sequencing strategies and management of adverse events across newly diagnosed and relapsed/refractory (R/R) settings.
EP. 1: MonumenTAL-1: Outcomes From the Extended Median Follow-Up Data
Panelists discuss how bispecific antibodies have evolved in relapsed/refractory myeloma treatment, highlighting recent data developments, the importance of NCCN guideline updates, including prophylactic tocilizumab recommendations, and strategies for improving toxicity management and community practice implementation.
EP. 2: MonumenTAL-1: Outcomes From the Extended Median Follow-Up Data (Part 2)
Panelists discuss how the extended median follow-up data from the MonumenTAL-1 trial demonstrate that Q2 weekly dosing of talquetamab shows superior progression-free survival (11.2 vs 7.5 months), duration of response (19.5 vs 7.5 months), and overall survival compared with weekly dosing, with particularly encouraging efficacy in high-risk cytogenetics and older patients while maintaining a manageable safety profile.
EP. 3: Data Review of Teclistamab and Elranatamab in R/R MM
Panelists discuss how recent long-term follow-up data for teclistamab and elranatamab reaffirm their effectiveness in relapsed/refractory multiple myeloma (R/R MM) with no new safety signals, while emphasizing that direct comparisons between B-cell maturation antigen (BCMA) bispecifics may not be fair due to evolving mitigation strategies, improved supportive care practices, and different study conditions including the impact of COVID-19 on early trials.
EP. 4: Expert Opinion on Modern Availability of Several Agents
Panelists discuss how the availability of multiple B-cell maturation antigen (BCMA) bispecific agents (with linvoseltamab approved in Europe and other agents in development) creates beneficial competition that could drive down costs and provide more treatment options, while acknowledging that safety and efficacy profiles appear comparable across agents, making accessibility and convenience key differentiating factors for patient care.
EP. 5: Future of R/R MM: Emerging Bispecifics and Trispecifics
Panelists discuss how the emerging trispecific antibody (targeting both T cells and natural killer [NK] cells) has generated significant excitement with its unprecedented 100% overall response rate in B-cell maturation antigen (BCMA)–exposed patients, while incorporating lessons learned from earlier bispecifics such as starting with Q4 weekly dosing and built-in tocilizumab prophylaxis, although they acknowledge this breakthrough may completely reshape treatment sequencing strategies and create new challenges in determining optimal therapy combinations.
EP. 6: Optimal Dosing of Talquetamab
Panelists discuss how to operationalize talquetamab dosing in community settings by addressing the main challenges of infection risk and skin toxicity through patient education, proactive monitoring protocols, and careful patient selection, with early community experience showing manageable toxicity rates and the importance of setting proper expectations about skin and nail changes as markers of drug activity rather than concerning adverse effects.
