Real-world evidence is demonstrating the adaptability of teclistamab (Tecvayli) in treating relapsed/refractory multiple myeloma (RRMM), with data focusing on dose adjustments and outpatient administration. These findings, presented by Hana F. Safah, MD, from Tulane University School of Medicine, and across several studies, are refining how this bispecific antibody is used in clinical practice.
Reduced Hospitalization with Teclistamab
Analysis from a National All-Payer Claims Database showed a reduction in hospitalization duration for patients undergoing step-up dosing of teclistamab. The mean length of stay decreased from 11.4 days in early 2023 to 7.0 days by mid-2024. According to Dr. Safah, this improvement reflects increased familiarity and expertise in managing the treatment. The study, which included 182 patients, also reported a 41% rate of cytokine release syndrome (CRS) among hospitalized patients, with most cases being grade 1 or 2.
Dose De-escalation and Frequency Adjustments
Real-world observations indicate that physicians are adjusting teclistamab dosing schedules based on individual patient needs. A study involving 419 patients revealed that less frequent dosing was implemented in 78 patients. By 9 months, 46% of patients were receiving less frequent doses. Interestingly, this dose de-escalation did not significantly impact outcomes, with only 3.8% of patients on less frequent dosing requiring a subsequent line of therapy, compared to 11.7% overall. These data suggest that dose adjustments can be made, especially in responding patients, without compromising efficacy.
Outpatient Administration of Teclistamab
The OPTec trial (NCT05972135) explored the feasibility of outpatient teclistamab administration. In this small study of 11 patients, tocilizumab (Actemra) was given prophylactically before the first dose, and patients were equipped with tools for remote communication with physicians. The results showed no cases of CRS or ICANS (immune effector cell–associated neurotoxicity syndrome), and 5 patients achieved good remission. A separate real-world data collection on 45 patients undergoing outpatient step-up dosing reported a 28.9% CRS rate, predominantly grade 1, further supporting the feasibility of outpatient administration in appropriately selected and monitored patients.
Insights from Memorial Sloan Kettering
Another study from Memorial Sloan Kettering Cancer Center divided patients into early and recent initiators of teclistamab, with the latter group receiving less frequent dosing. The overall response rates were similar between the two groups (67% vs. 57%), as were the 6-month progression-free survival (53.3% vs. 52.3%) and duration of response (70.0% vs. 82.1%). These findings reinforce the idea that teclistamab dosing can be tailored to patient needs without sacrificing efficacy.
These real-world experiences are providing valuable insights into the practical application of teclistamab, supporting more flexible and patient-centered treatment approaches.
