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Hematologic Malignancies • Medical Oncology • Myeloma • NCI-CCC Tumor Board Question • University of Washington • NCI-CCC Myeloma Tumor Board Question • Multiple Myeloma
For patients on commercial teclistamab who achieve a response, are there patient-specific or response-specific parameters that would prompt you to de-escalate therapy from once per week?
For example - minimum number of months of therapy, driving distance to clinic, at least a CR with or without MRD negativity?
Answer from: Medical Oncologist at Academic Institution
I think it’s safe to say we really lack good evidence to guide us.
However, we must balance the risk of persistent immunosuppression with teclistamab and its efficacy. The only piece of data I am aware of in this regard comes from ASCO 2023 in an abstract by @Saad Z. Usmani.
In the Maje...
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Answer from: Medical Oncologist at Academic Institution
We have started to de-escalate quickly, particularly for our elderly patients, who are having more difficulty tolerating teclistamab. Once the patients achieve at least a PR (which seems to be apparent within 2 cycles), we have been moving to q 2 weeks and even monthly, with what appears to be bette...
Answer from: Medical Oncologist at Community Practice
I reviewed the investigator brochure for all the FDA-approved bispecific antibodies, and saw very little pharmacokinetic (PK) or pharmacodynamic (PD) data.
Hence, for patients that achieve a ≥VGPR after 1 month of weekly treatment, it's appealing to switch to monthly dosing for BCMA-direct...