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Prophylactic Tocilizumab May Enhance Access to Bispecific Therapies for Multiple Myeloma

Prophylactic use of tocilizumab could reduce the risk of cytokine release syndrome and neurotoxicity in patients with relapsed/refractory multiple myeloma receiving bispecific antibodies, potentially enabling safer outpatient administration. The OPTec study is evaluating this approach, with initial results suggesting benefits for patient access and safety.

Prophylactic tocilizumab has shown potential in decreasing cytokine release syndrome and neurotoxicity associated with bispecific antibodies, according to Robert Rifkin, MD, a medical oncologist and hematologist. This reduction in adverse events could facilitate the administration of these therapies in outpatient community settings, thereby increasing patient access.
The OPTec study is currently assessing the use of prophylactic tocilizumab in patients with relapsed/refractory multiple myeloma who are receiving the bispecific antibody teclistamab. Preliminary findings indicate that prophylactic tocilizumab may lower the risk of developing cytokine release syndrome, making outpatient administration safer. The study continues to enroll participants for further analysis.
In addition to teclistamab, the study is exploring the benefits of prophylactic tocilizumab for patients on talquetamab, another bispecific antibody. Talquetamab presents a different toxicity profile, including dysgeusia, hair and nail changes, weight loss, and loss of appetite. Strategies are being implemented to mitigate these unique toxicities, with ongoing monitoring for infections.
The potential of prophylactic tocilizumab is also being examined in the context of dual bispecific regimens and trispecific antibodies under development. These therapies aim to target multiple myeloma with reduced toxicity. The RedirecTT-1 study, which combines talquetamab and teclistamab, has shown promising results. Efforts are underway to engineer these agents to minimize cytokine release syndrome and neurotoxicity, alongside strategies like debulking to reduce tumor burden before therapy.
Despite the potential benefits, concerns have been raised regarding the cost of prophylactic tocilizumab, especially for Medicare beneficiaries. Current labels for bispecific antibodies and CAR T-cell therapies do not include tocilizumab, and obtaining coverage can be challenging. However, persistence in advocating for its use may lead to broader acceptance and coverage.
References:
  1. Rifkin R, Schade H, Simmons G, et al. Optec: a phase 2 study to evaluate outpatient step-up administration of teclistamab in patients with relapsed/refractory multiple myeloma (RRMM): updated results. Presented at: ASH 2024; December 7-10, 2024; San Diego, CA. Abstract 4753.
  2. Cohen Y, Morillo D, Gatt ME, et al. First results from the RedirecTT-1 study with teclistamab (tec) + talquetamab (tal) simultaneously targeting BCMA and GPRC5D in patients (pts) with relapsed/refractory multiple myeloma (RRMM). J Clin Oncol. 2023;41(suppl 16). doi:10.1200/JCO.2023.41.16_suppl.80
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Reference News

[1]
Prophylactic Tocilizumab Could Increase Community Access to Bispecifics for MM
ajmc.com · Dec 11, 2024

Prophylactic tocilizumab may reduce cytokine release syndrome and neurotoxicity in patients receiving bispecific antibod...

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