Optimal Dosing of Talquetamab (Part 2)
Panelists discuss how outpatient administration of talquetamab is becoming more feasible with proper patient selection, noting that although there are few absolute medical contraindications to bispecifics, they exercise caution in patients with dialysis dependency (due to different pharmacokinetics), spinal cord compression (due to inflammatory response concerns), decompensated heart failure, or active infections, while emphasizing that most myeloma patients who desire continued therapy should not be denied bispecific treatment.
EP: 1.MonumenTAL-1: Outcomes From the Extended Median Follow-Up Data
EP: 2.MonumenTAL-1: Outcomes From the Extended Median Follow-Up Data (Part 2)
EP: 3.Data Review of Teclistamab and Elranatamab in R/R MM
EP: 4.Expert Opinion on Modern Availability of Several Agents
EP: 5.Future of R/R MM: Emerging Bispecifics and Trispecifics
EP: 6.Optimal Dosing of Talquetamab
EP: 7.Optimal Dosing of Talquetamab (Part 2)
EP: 8.Talquetamab: Real-World Outcomes With Outpatient Dosing
Optimal Dosing of Talquetamab (Continued)
The discussion expands on patient selection criteria for bispecific antibody therapy, addressing specific populations that may require additional consideration or inpatient monitoring. Dialysis patients represent a unique category that was typically excluded from registration trials but has shown feasibility in published case series. These patients present distinct challenges due to altered volume of distribution and potentially different cytokine release syndrome patterns, making careful monitoring essential. The experience suggests that with appropriate precautions, even dialysis-dependent patients can safely receive bispecific therapy.
Medical contraindications to bispecific therapy are limited, with most experts agreeing that very few absolute contraindications exist. The primary concern involves patients with spinal disease adjacent to the spinal cord, where local inflammatory responses could potentially cause complications. In such cases, disease reduction before bispecific initiation may be prudent. Other relative contraindications mentioned include active ongoing infections (per labeling) and decompensated heart failure, where patients might not tolerate potential adverse effects, although these represent cautious approaches rather than absolute barriers.
The philosophy of treatment accessibility emphasizes that bispecific antibodies have expanded treatment options for patients who previously would not have been candidates for intensive therapies like stem cell transplantation or chimeric antigen receptor T-cell therapy. The panel’s experience includes successfully treating patients with significant comorbidities, including heart failure and other conditions that would have made them ineligible for clinical trials. The approach involves individualized risk assessment, with higher-risk patients receiving inpatient monitoring during treatment initiation. This inclusive approach reflects the broader applicability of bispecific antibodies compared to more intensive cellular therapies, potentially offering life-extending treatment to a wider population of patients with multiple myeloma who might otherwise have limited therapeutic options.
