A Review of Outpatient Step-Up Dosing for Talquetamab in R/R MM

EP: 1.Later R/R MM Treatment Landscape and Unmet Needs

EP: 2.ASCO 2025: MonumenTAL-1 Extended Follow-Up for Talquetamab in R/R MM

EP: 3.Insights From MonumenTAL-1: Impressions of Updated Efficacy Outcomes

EP: 4.MonumenTAL-1: Implications of Talquetamab, Prior TCR, and Sequencing for R/R MM

EP: 5.Safety Updates and Concluding Thoughts From Extended Follow-Up of MonumenTAL-1

EP: 6.Talquetamab in R/R MM: Managing GPRC5D-direced AEs, Prophylaxis, and New Safety Signals

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EP: 7.A Review of Outpatient Step-Up Dosing for Talquetamab in R/R MM

EP: 8.Real-World Use, Outpatient Dosing and Transitions of Care in Academic and Community Settings

The feasibility of outpatient step-up dosing for talquetamab has been demonstrated through real-world clinical experience, offering significant advantages for patient convenience and health care system efficiency. Retrospective data from Mayo Clinic showed successful outpatient management in 85% of 28 heavily pretreated patients, with minimal hospitalization requirements during the step-up dosing period. This approach requires careful patient selection, comprehensive staff education, and established protocols for managing cytokine release syndrome (CRS) in the outpatient setting.

Current outpatient management strategies emphasize early intervention for CRS symptoms, with liberal use of tocilizumab and dexamethasone even for grade 1 symptoms to prevent progression to higher-grade toxicities. Many centers maintain 24-hour clinic access or established emergency department protocols to ensure rapid response to treatment-related complications. The relatively low rate of grade 3 CRS (approximately 1.5%) makes outpatient management feasible with appropriate infrastructure and monitoring capabilities.

Emerging strategies include prophylactic tocilizumab administration, now supported by NCCN guidelines, which could further reduce CRS severity and facilitate broader outpatient implementation. Community-based practices are exploring various approaches, including providing patients with dexamethasone for home administration, establishing relationships with local emergency departments for after-hours care, and implementing electronic medical record alerts to ensure appropriate recognition and management of bispecific-related complications across different health care settings.