Binod Dhakal, MD, MS

Panelists discuss how comprehensive supportive care strategies for GPRC5D bispecifics like talquetamab involve managing unique toxicities including taste and smell changes, skin and nail effects, and gastrointestinal issues, with one patient emphasizing her philosophy of addressing adverse effects as they arise rather than anticipating them, while highlighting the importance of continued research funding for innovative treatments that have extended her survival beyond initial prognosis.

Panelists discuss how the step-up dosing strategy for talquetamab involves graduated dose escalation from 0.01 to 0.06 mg/kg before reaching therapeutic levels to minimize severe cytokine release syndrome, with real-world data showing 85% to 86% of patients can safely receive outpatient step-up dosing, though one patient’s inpatient experience was chosen due to her drug allergies and travel distance considerations.

Panelists discuss how talquetamab demonstrates impressive clinical efficacy with approximately 70% response rates in the pivotal MONUMENTAL-1 trial, including patients previously treated with other immunotherapies, and how real-world data from studies like Real Italy corroborate these trial results with similar 67% response rates across diverse patient populations including high-risk subgroups.

Panelists discuss how clinical decision-making between GPRC5D and BCMA-targeting bispecific antibodies involves considering prior treatment history, target switching strategies, and patient-specific factors, with Karen explaining her preference for talquetamab's targeted approach that spares healthy cells, subcutaneous administration convenience, and the advantage of switching to a different antigen target after previous BCMA therapy.

Panelists discuss how bispecific antibodies like talquetamab work through dual targeting mechanisms that bring T-cells and cancer cells together for tumor destruction, with patient Karen sharing her decision-making process based on treatment convenience, manageable adverse effects like taste loss and nail changes, and the therapy's effectiveness after initial severe reactions during step-up dosing.

Panelists discuss how multiple myeloma patients navigate complex treatment journeys through multiple relapses, clinical trials, and the transformative potential of bispecific antibody therapies like talquetamab, with patient Karen Kehl sharing her 15-year experience from initial diagnosis through 19 treatment cycles including three transplants and various clinical trials.

Panelists discuss how talquetamab’s unique targeting mechanism offers significant advantages for patients with prior T-cell therapy exposure, whereas future research should focus on combination strategies and understanding primary resistance mechanisms.

Panelists discuss how successful outpatient bispecific therapy requires robust infrastructure, including 24-hour monitoring capabilities, emergency department coordination, and liberal use of supportive medications.

Panelists discuss how findings from a Mayo Clinic retrospective study demonstrate the feasibility and safety of outpatient step-up dosing for talquetamab, with minimal hospitalizations required.

Panelists discuss how cytokine release syndrome can be managed through early intervention with tocilizumab and steroids, and emphasize the importance of patient and staff education for safe outpatient administration.

Panelists discuss how talquetamab shows a more favorable safety profile with significantly lower high-grade infection rates compared with B-cell maturation antigen (BCMA)–directed bispecifics, although a new cerebellar toxicity signal requires monitoring.

Panelists discuss how talquetamab demonstrates remarkable efficacy in patients previously exposed to T-cell redirecting (TCR) therapies, with response rates and duration comparable to treatment-naive patients.

Panelists discuss how the extended follow-up data show unprecedented overall survival outcomes, with the every-2-week dosing appearing more tolerable and leading to better long-term outcomes than weekly dosing.

Panelists discuss how talquetamab targets GPRC5D, which is heavily expressed on malignant plasma cells but not normal B cells, potentially explaining lower infection rates compared with B-cell maturation antigen (BCMA)–targeted therapies.

Panelists discuss the unmet need for effective therapies in early-relapse multiple myeloma, where patients have exhausted standard treatments but do not yet qualify for bispecific therapies or CAR T cells.

Life After CAR T: Patient and Clinical Perspectives on the Promise of CAR T in Multiple Myeloma

Panelists discuss how health care centers provide comprehensive long-term monitoring and support services for both patients receiving CAR T and their caregivers in the posttreatment period, including regular medical assessments and ongoing educational resources.

Panelists discuss how patients and medical teams navigate the complex CAR T therapy journey, from initial referral through cell collection, manufacturing, and infusion, while highlighting crucial monitoring strategies for managing adverse effects such as cytokine release syndrome and neurotoxicity.

Panelists discuss how a patient and their medical team collaborated to evaluate the differences between ide-cel and cilta-cel CAR T therapies to make an informed treatment decision.

Panelists discuss how clinical trial data from CARTITUDE-1, CARTITUDE-4, and KarMMa-3 demonstrate the efficacy of CAR T therapies cilta-cel and ide-cel in multiple myeloma, comparing their real-world outcomes and considering patient-specific factors for treatment selection.

Panelists discuss how health care providers engage in vital conversations with patients about CAR T therapy, focusing on comprehensive education, emotional support, and clear communication about the treatment journey ahead.

Panelists discuss how the symptoms of a patient with multiple myeloma led to their initial diagnosis and the progression of various treatments they underwent before becoming a candidate for CAR T therapy.

Panelists discuss how looking ahead, key takeaways from the CARTITUDE-4 study underscore the transformative potential of ciltacabtagene autoleucel in managing lenalidomide-refractory multiple myeloma, highlighting its efficacy, safety, and implications for future treatment strategies.

Panelists discuss how addressing unmet needs and future directions for enhancing bispecific therapy care transitions in multiple myeloma requires focusing on standardized protocols, technology integration, personalized patient support, and continuous education for both patients and healthcare providers across academic and community settings.

Panelists discuss how optimizing patient reintegration into community care after receiving bispecific therapy for multiple myeloma at academic centers requires a coordinated, patient-centered approach involving clear communication, standardized transition protocols, ongoing education, and collaborative care models between academic and community oncologists.

Panelists discuss how the safety data from the long-term CARTITUDE-4 update demonstrate a manageable adverse event profile for ciltacabtagene autoleucel, supporting its continued use in patients with lenalidomide-refractory multiple myeloma.

Panelists discuss how enhancing communication between academic and community oncologists during the referral and treatment process for multiple myeloma patients requires a multifaceted approach involving standardized protocols, technology integration, regular collaborative meetings, and shared decision-making to ensure seamless patient care and optimal outcomes.

Panelists discuss how comprehensive long-term monitoring protocols for patients who have received bispecific therapy typically involve regular follow-ups, standardized testing schedules, and clear communication channels between academic centers and community practices to manage potential complications and adverse events.

Panelists discuss how determining a patient's readiness to transition back to community oncology care after bispecific therapy involves assessing multiple factors including treatment response, toxicity resolution, overall stability, and the community practice's capabilities.

Panelists discuss how data from the long-term CARTITUDE-4 update reveal a notable rate of minimal residual disease (MRD) negativity with ciltacabtagene autoleucel, emphasizing its potential to enhance long-term outcomes in patients with lenalidomide-refractory multiple myeloma.