Real World Experience of Talquetamab in R/R Myeloma Patients | Ariel Grajales Cruz, MD | #ASH24

I am Ariel Grajales Cruz from the Moffitt Cancer Center in Tampa, Florida, and I'm on one of the myeloma doctors in the malignant hematology section. Today we're going to be talking about a poster session abstract that was accepted for the single center experience in Talcuadema for patients with relapse refractory myeloma, which has been approved for over a year now. And we're getting more and more familiarized with these type of therapies by specific antibodies nowadays were approved as a fifth line of therapy after four prior lines of therapy. And this is for a patient population that is in desperate needs of newer therapies, right? Because ultimately myeloma remains an incurable disease. And the fact that we have the opportunity to present such data with outstanding results, with very deep responses and with a relatively safe toxicity profile, although we have to admit that there are some adverse events that we have to be aware of, it's very encouraging altogether. So in our experience, we have treated 60 patients so far with Talcuadema, like I said, after four prior lines of therapies, the median line of therapy that we had in our institution was 6.5, so heavily treated population altogether, and mainly with high risk biology and clinical presentation. We had around close to 50% of the patients with high risk cytogenetics, and those high risk mutations are typically more complicated and difficult to treat, of course, with shorter responses, durations of response. And we also have patients that had extra medullary disease. In other words, disease that was not necessarily detected in the blood, but they had plasma cytomas somewhere. We also had a patient population that was very frail as well, because typically clinical trials do include mostly patients that are very fit and that fit a parameter numerically. And so we knew that it was not an easy population to treat, and however, we had an overall response rate of 80%, which was absolutely mind blowing for a single agent activity in this type of setting. Out of that 80%, close to 50% achieved a CR rate or better. So again, very deep responses, and that's very encouraging, right? Because ultimately these are patients that have a good proportion of them had received prior BCMA target therapies, either in the form of CAR T cell therapy or another BCMA by specific antibody, such as the Eclistma borrel ranatoma. And it's encouraging, right? Because we know that we have something to offer for these patients. It was monotherapy, and it was given in two settings, either as a primary treatment, and it was also given as a bridge to CAR T cell therapy for some patients that we just needed to get something to stabilize the disease after collection of the cells and the manufacturing to get them CAR T ready. We had 19 patients in that setting, and again, with great results altogether, we were able to debulk a significant proportion of the disease for those and to get them ready to get to this CAR T cell therapy afterwards. Toqorabab has a very particular toxicity profile. We know that these by specific antibodies can all cause cytopenia, some GI toxicities, but there is a very particular GI toxicity that we have to be aware of, and it's dysgousia, the outer taste. Unfortunately, these patients can't present with a significant dysgousia. This outer taste was seen in more than half of the patients, which was 70% of the patients were having dysgousia. The problem was that this had a clinical implication, because as soon as you start losing your taste, your weight can go down, and we have 40% of our patients losing weight, which is not a negligible number altogether. We also saw some skin and nail-related changes, and I would say those are the most common, the most relevant toxicities. From by specific antibodies, we know that we have CRS, or the cytokine release syndrome, and ICANS that can occur, and this is just from an over-stimulation of the immune system. But we have to make sure that we find good mitigation strategies to minimize the risk of these toxicities that will have an impact in the quality of life, because these outer tastes can be a problem for the patients for sure. Like I said, this is a patient population that is in desperate need of new therapies, because we have to acknowledge that 20 years ago, the survival for a patient with newly diagnosed myeloma was two to three years. So we've come a long way. We still have room for improvement, for sure, because ultimately we want to not only extend this duration of their lifetime for the longest period of time, but we also have to make sure that the risk and benefit ratio makes sense. The quality of life has to be there for them, and that's where there's always room for improvement. But this is a very encouraging start. I think we're heading in a very good direction, and we're wishful and hopeful, for sure. Biperspecific antibodies and other novel cell therapies are here to stay, and we see that it's not only in multiple myeloma. We have now, bispecific antibodies approved for some lymphomas and even for small cell lung cancer. So we're changing the treatment paradigm to some extent, and it's absolutely fantastic to be a part of it and to change the treatment landscape. It's just a matter of keeping getting better, keep pushing, and doing what's right for the patients.