Johnson & Johnson's TALVEY® (talquetamab), a first-in-class bispecific antibody targeting CD3 and GPRC5D, has successfully navigated regulatory pathways to address the critical unmet need in patients with relapsed or refractory multiple myeloma. The approvals, however, came with careful consideration of the drug's complex side effect profile.
Balancing Efficacy and Safety
TALVEY, like J&J's other bispecific antibody TECVAYLI (teclistimab), presents a novel approach by binding to both T-cells and cancer cells, thereby stimulating the immune system to target the malignancy. Both drugs were initially approved for heavily pre-treated relapsed/refractory multiple myeloma, a particularly aggressive form of the disease with limited treatment options and poor prognosis.
Accelerated Approval Pathways
J&J strategically utilized the United States Food and Drug Administration’s (FDA) Accelerated Approval Program and the European Commission’s Conditional Marketing Authorization (CMA) to expedite patient access to both TECVAYLI and TALVEY. TECVAYLI received CMA in August 2022 and FDA Accelerated Approval in February 2024. TALVEY secured FDA Accelerated Approval in August 2023, followed by a CMA later that month. These pathways are designed for novel medications addressing serious conditions with unmet needs, relying on surrogate endpoints or less comprehensive clinical data.
Risk Mitigation Strategies
Due to the potential for severe side effects, including neurotoxicity, hepatotoxicity, and cytokine release syndrome, the availability of both TALVEY and TECVAYLI is restricted in the U.S. under a joint Risk Evaluation and Mitigation Strategy (REMS). Furthermore, CMAs require annual renewal, reflecting the ongoing monitoring and evaluation of the benefit-risk profile.
Combination Therapies and Future Directions
J&J's RedirecTT-1 study is currently evaluating the potential of combining TALVEY and TECVAYLI in patients with relapsed or refractory multiple myeloma who have been exposed to three major drug classes. The study includes patients with extramedullary disease, where the cancer has spread beyond the bone marrow, representing a particularly challenging subgroup.
