Comorbidities May Influence Teclistamab Induction Regimen Use in NDMM

At the 22nd Annual International Myeloma Society Meeting and Exposition, CancerNetwork® spoke with Marc S. Raab, MD, PhD, about his work on the phase 2 MajesTEC-5 study (NCT05695508) evaluating induction therapy with different teclistamab-cqyv (Tecvayli)–containing regimens for patients with newly diagnosed multiple myeloma (NDMM). Across multiple induction therapy arms in the MajesTEC-5 trial, investigators combined teclistamab with agents such as daratumumab (Darzalex), bortezomib (Velcade), and lenalidomide (Revlimid). Based on the updated findings, Raab highlighted the factors to consider when selecting one teclistamab-based combination over another.

According to Raab, a professor of medicine and clinical director of the Heidelberg Myeloma Center and the Department of Medicine V at the Heidelberg University Hospital, it may be less suitable to administer frontline bispecific antibodies if patients have comorbidities, poor performance statuses, or prior severe infections. Additionally, he highlighted how the safety profile of teclistamab-based treatment in this trial was expected based on the familiar individual compounds of each combination. He noted that patients who are eligible for treatment with daratumumab plus lenalidomide, bortezomib, and dexamethasone (Dara-RVd) may also be candidates to undergo induction therapy with regimens including teclistamab plus daratumumab.

Transcript:

As with all combination therapies, you need to look for comorbidities. If a patient’s performance status is poor, or he already has severe infections in his history, [or] for other reasons like chronic immunodeficiency or so, then I would be cautious in adding a bispecific in frontline therapy to those patients. On the other hand, what we see is that, except for some of the infections, the [adverse] effect rate is otherwise as we would expect it from the known compounds that are used in this combination regimen. Nothing new came up because of the combination regimen. Whenever you would have considered a patient eligible for a standard Dara-RVd induction regimen, you can also consider this patient for [teclistamab plus daratumumab] induction regimen. That is fair to say.

Reference

Raab MS, Weinhold N, Kortum KM, et al. Post-induction outcomes and updated minimal residual disease analysis from GMMG-HD10/DSMM-XX (MajesTEC-5): a study of teclistamab-based induction regimens in newly diagnosed multiple myeloma (NDMM). Presented at the 22nd Annual International Myeloma Society Meeting and Exposition; September 17-20, 2025; Toronto, Canada. Abstract OA-13.