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How it is administered
Teclistamab is given as a subcutaneous injection (an injection under the skin). It is supplied in single-dose vials and is administered by a healthcare provider.
The dosing schedule starts with two step-up doses (0.06 mg/kg and 0.3 mg/kg) given a few days apart, followed by a regular treatment dose of 1.5 mg/kg once weekly. If patients achieve and maintain a complete response for at least 6 months, the dosing frequency may be reduced to every two weeks. Patients are usually hospitalized for 48 hours after each of the first three doses to monitor for side effects.
How it works
Teclistamab is a bispecific antibody designed to help your immune system fight multiple myeloma. It works by binding to two different targets: the CD3 receptor on T-cells (a type of immune cell) and the B-cell maturation antigen (BCMA) on multiple myeloma cells.
By connecting T-cells to myeloma cells, teclistamab activates the T-cells, which then attack and kill the cancer cells. This process also causes the release of immune signaling molecules called cytokines, which help in the immune response but can also lead to side effects like cytokine release syndrome (CRS). Teclistamab is specifically used in patients whose myeloma has returned or not responded to several other treatments.
Common side effects
Common side effects of teclistamab include:
- Fever (pyrexia)
- Cytokine release syndrome (CRS)
- Musculoskeletal pain (such as muscle or joint pain)
- Injection site reactions (redness, swelling, or discomfort)
- Fatigue
- Upper respiratory tract infection
- Nausea
- Headache
- Pneumonia
- Diarrhea
Laboratory abnormalities may include decreased lymphocytes, neutrophils, white blood cells, hemoglobin, and platelets. Serious side effects can include infections, liver problems, neurologic toxicity (including confusion or seizures), and severe allergic reactions.
Who Should take it
Teclistamab is indicated for adults with relapsed or refractory multiple myeloma. This means it is used in patients whose disease has come back or has not responded to previous treatments.
It is specifically approved for patients who have received at least four prior lines of therapy, including a proteasome inhibitor, an immunomodulatory agent, and an anti-CD38 monoclonal antibody. This medication is generally considered when other standard treatments have not worked.
Who should not take it
There are no absolute contraindications listed for teclistamab. However, it should not be used in patients who are allergic to any of its ingredients.
Women who are pregnant or may become pregnant should avoid teclistamab, as it may cause harm to an unborn baby. Women should use effective contraception during treatment and for 5 months after the last dose. The safety and effectiveness of teclistamab in children have not been established.
Commonly used with
Teclistamab is typically used alone in patients who have already tried several other treatments for multiple myeloma. Before starting teclistamab, patients will have already received medications such as proteasome inhibitors, immunomodulatory agents, and anti-CD38 monoclonal antibodies.
During treatment, supportive medications such as corticosteroids, antihistamines, and acetaminophen are given before each dose to reduce the risk of side effects like CRS. Antiviral medications may also be used to prevent infections such as herpes zoster.
Commonly tested with
Teclistamab has been studied in patients who have previously been treated with other multiple myeloma therapies, including proteasome inhibitors, immunomodulatory agents, and anti-CD38 monoclonal antibodies.
In clinical trials, teclistamab was not tested in combination with other anti-myeloma drugs, but supportive medications (like dexamethasone, diphenhydramine, and acetaminophen) were used to manage side effects. Ongoing studies may explore its use in combination with other treatments in the future.
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