Teclistamab for Relapsed or Refractory Multiple Myeloma: Managing Side Effects and Long-Term Outcomes

Teclistamab, marketed as TECVAYLI®, is a B-cell maturation antigen (BCMA) × CD3 bispecific antibody used to treat adults with relapsed or refractory multiple myeloma. Whereas highly effective, treatment with teclistamab can cause side effects that require careful management. Recent research, including long-term follow-up from the MajesTEC-1 trial, provides valuable insights into managing these side effects and understanding the drug’s sustained efficacy.

Understanding Teclistamab and Multiple Myeloma

Multiple myeloma is a cancer that affects plasma cells, a type of white blood cell. Teclistamab works by directing the body’s own T cells to recognize and kill myeloma cells. It is specifically designed for patients whose cancer has returned after previous treatments or has not responded to initial therapies.

Key Findings from the MajesTEC-1 Trial

The MajesTEC-1 trial, a phase 1/2 clinical study, has been pivotal in evaluating the efficacy and safety of teclistamab. Initial results demonstrated a significant response rate, with 63% of participants experiencing improvement in their multiple myeloma [1]. Long-term follow-up continues to provide valuable data.

Common Side Effects and Their Management

Two of the most common side effects observed in the MajesTEC-1 study are cytokine release syndrome (CRS) and infections.

Cytokine Release Syndrome (CRS)

CRS is an inflammatory response that can occur when bispecific antibodies like teclistamab activate the immune system. In the MajesTEC-1 trial, 72% of participants developed CRS [1]. However, the majority of cases were low grade and manageable, particularly during the initial stages of treatment when lower doses of teclistamab were administered. Importantly, no patients discontinued teclistamab treatment solely due to CRS [1].

Infections

A significant proportion of patients (80%) experienced infections while receiving teclistamab [1]. Some participants exhibited low levels of immune cells and antibodies, compromising their ability to fight off infections. Screening for existing infections is crucial before initiating teclistamab treatment and any ongoing infections should be fully resolved prior to starting therapy.

Sustained Responses with Long-Term Follow-Up

Recent data from the MajesTEC-1 trial, presented in May 2024, demonstrate sustained deep and durable responses in patients with relapsed or refractory multiple myeloma [4]. This long-term follow-up reinforces teclistamab’s potential as an effective treatment option for this challenging cancer.

Key Takeaways

• Teclistamab is an effective treatment for relapsed or refractory multiple myeloma.
• CRS and infections are common side effects, but are generally manageable with careful monitoring.
• Patients should be screened for infections before starting teclistamab, and any existing infections should be resolved.
• Long-term follow-up data supports the sustained efficacy of teclistamab.

Access to Support and Information

For healthcare professionals seeking more information, Johnson & Johnson Medical Connect provides resources related to the MajesTEC-1 study [3].