Presenting Author: Donald Moore, PharmD, BCPS, BCOP, DPLA, FCCP, FASHP, Atrium Health Levine Cancer Institute, Charlotte, NC
BACKGROUND: Talquetamab is a GPRC5D-directed bispecific antibody approved for the treatment of relapsed or refractory multiple myeloma (RRMM). Cytokine release syndrome (CRS) occurred frequently (approximately 76%) with talquetamab in the MonumenTAL-1 study. The International Myeloma Working Group guidelines recommend tocilizumab for low-grade CRS (grade 1 or 2).
OBJECTIVE: To compare the efficacy of dexamethasone versus tocilizumab for talquetamab-induced CRS management.
METHODS: A multicenter, retrospective study was conducted across 7 academic medical centers that included patients who received commercial talquetamab for RRMM. All patients received premedications and a talquetamab step-up dose (SUD) schedule per the prescribing information. CRS was graded using the American Society for Transplantation and Cellular Therapy criteria. The outcomes included the incidence and severity of CRS, recurrent CRS rate, overall response rate, and healthcare resource utilization.
RESULTS: A total of 211 patients were included. Patients received a median of 6 previous lines of therapy (range, 2-14). Talquetamab was used as bridging therapy in 53 (35%) patients. A SUD schedule of days 1, 3, 5, and 7 was used most often (63%). CRS occurred in 129 (61%) patients and was primarily low grade (grade 1, 43%; grade 2, 16%; grade 3 or 4, 1%). In all, 46 (36%) patients and 42 (33%) patients received dexamethasone and tocilizumab, respectively, as their initial CRS management and were included in the primary efficacy outcome analysis. The median dose of dexamethasone was 10 mg (range, 8-16 mg). In the dexamethasone group, 72% and 24% of patients had grade 1 and grade 2 CRS, respectively. CRS resolved with either a single dexamethasone dose (46%), repeated dexamethasone dosing (22%), or subsequent tocilizumab treatment (20%). In the tocilizumab group, CRS resolved with a single dose, repeat doses, or subsequent dexamethasone treatment in 71%, 12%, and 17% of patients, respectively. Recurrent CRS after a subsequent SUD was more common with initial dexamethasone (50% vs 15%; P=.005); however, all repeat events were low grade and resolved with dexamethasone and/or tocilizumab. The overall response rates (86% vs 90%; P=.74) and rates of very good partial responses or better (52% vs 56%; P=.83) were similar between the dexamethasone and tocilizumab cohorts. For healthcare resource utilization, there were no significant differences between the dexamethasone and tocilizumab cohorts for hospitalization duration during SUD (9 days vs 10 days; P=.34) or intensive care unit admission during SUD (7% vs 9%; P=.70).
CONCLUSION: Although more patients had recurrent CRS with dexamethasone than with tocilizumab, subsequent events were low grade and generally manageable with repeated dexamethasone doses. Dexamethasone could be an alternative treatment option to tocilizumab for low-grade talquetamab-induced CRS.
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