Medically reviewed by Dr. Shani S. Saks, D.O. on August 2, 2023
Patients in a phase 1–2 study who were treated with teclistamab demonstrated a high rate of durable and deep therapeutic response. The treatment was safe and effective. Most of the toxic effects that were associated with T-cell redirection were categorized as grade 1 or 2.
The approach commonly taken to treat multiple myeloma involves the administration of immunomodulatory agents, proteasome inhibitors, and anti-CD38 antibodies. While these treatments have provided valuable benefits, the reality is that for patients who face disease progression after undergoing these therapies, the choices become notably limited.
This challenging situation often translates to less promising clinical outcomes, underscoring the pressing need for innovative solutions in such cases. Teclistamab, a T-cell-redirecting bispecific antibody, targets myeloma cells expressing B-cell maturation antigen and T cells expressing surface CD3. This study, published in The New England Journal of Medicine, investigated the safety and efficacy of teclistamab in triple-class-exposed refractory or relapsed multiple myeloma patients.
A total of 165 patients were enrolled in the study, and the median duration of the treatment was 8.5 (0.2–24.4) months. The median age of the patients was 64 (33–84) years, and the median time between the first teclistamab dose and diagnosis was 6 (0.8–22.7) years.
Efficacy of Teclistamab in Relapsed or Refractory Multiple Myeloma
The median duration of follow-up was 14.1 (0.3–24.4) months. Therapeutic responses were reported in 63% of the patients. The median time until the patients reported the best treatment response was 3.8 (1.1–16.8) months. The treatment response was relatively lower in patients with stage III disease, those with 60% marrow replacement with plasma cells, and those who had extramedullary disease. The treatment response was higher in patients who had previously not been administered more than three lines of therapy. The median overall survival duration was 18.3 months, and the median progression-free survival duration was 11.3 months.
Safety of Teclistamab in Relapsed or Refractory Multiple Myeloma
Grade 3 or 4 adverse events were reported in 156 patients. The most prevalent adverse events were hematologic events such as neutropenia, thrombocytopenia, and anemia. Cytokine release syndrome was observed in 119 patients, whereas 24 neurotoxic events were confirmed via investigator assessment. Approximately 41.2% of the patients died due to progressive disease.
Teclistamab is associated with a durable and deep treatment response in patients suffering from triple-class-exposed refractory or relapsed multiple myeloma. The adverse effects commonly included cytopenia and infections, which were mostly restricted to grade 1 or 2 toxic effects.
Moreau, P., Garfall, A. L., van de Donk, N. W. C. J., Nahi, H., San-Miguel, J. F., Oriol, A., Nooka, A. K., Martin, T., Rosinol, L., Chari, A., Karlin, L., Benboubker, L., Mateos, M.-V., Bahlis, N., Popat, R., Besemer, B., Martínez-López, J., Sidana, S., Delforge, M., & Pei, L. (2022). Teclistamab in Relapsed or Refractory Multiple Myeloma. New England Journal of Medicine, 387(6), 495–505.https://doi.org/10.1056/nejmoa2203478