Talquetamab (Talvey), a bispecific antibody used in the treatment of multiple myeloma, has shown a low incidence of neurological adverse events, according to recent data and expert observations. While neurological effects are a potential concern with bispecific antibodies, clinical experience and trial data suggest they occur infrequently and are generally manageable.
Clinical Observations
Samantha Shenoy, NP, MSN, a nurse practitioner at the Cancer Immunotherapy Clinic of University of California San Francisco Health (UCSF), noted that while neurological effects are possible with talquetamab, she has not personally observed them in her practice. UCSF, like many institutions, conducts Immune Effector Cell Encephalopathy (ICE) scores every 12 hours to monitor patients for neurological changes.
MonumenTAL-1 Study Findings
The phase 1/2 MonumenTAL-1 study (NCT03399799; NCT04634552) evaluated talquetamab in heavily pretreated patients with multiple myeloma. Common toxicities observed in the study included hypogammaglobulinemia, oral adverse effects, infections, anemia, and asthenia. Neurological effects were not among the most common adverse events reported across all dose levels.
Incidence of Neurotoxicity
A review published in Haematologica reported neurotoxicity in 10% and 5% of patients receiving 405 mcg and 800 mcg doses of talquetamab, respectively. These cases were generally low grade and resolved. In the phase 2 portion of the trial, immune effector cell-associated neurotoxicity syndrome occurred in 10.7% of patients who received talquetamab at 0.4 mg/kg and in 11% of those who received the agent at 0.8 mg/kg.
Monitoring and Management
The importance of vigilant monitoring for neurological effects was emphasized. Regular ICE scoring, typically performed every 12 hours, allows for early detection and management of any neurological changes that may arise during treatment with talquetamab.
