Multiple myeloma is a blood cancer originating in plasma cells. These abnormal cells multiply uncontrollably, producing dysfunctional proteins and crowding out healthy blood cells. Teclistamab represents a targeted treatment approach for patients whose cancer has progressed despite other therapies.
Understanding Teclistamab
Teclistamab is a bispecific antibody designed to bind to two different targets simultaneously, creating a bridge between the body’s immune system and cancer cells. One part of teclistamab attaches to B-cell maturation antigen (BCMA) on multiple myeloma cells. The other part binds to CD3 on a patient’s T-cells.
By connecting these two targets, teclistamab brings the patient’s T-cells into close proximity with the multiple myeloma cancer cells. This interaction allows the T-cells to recognize and attack the cancerous cells, leading to their destruction.
Who Can Receive Teclistamab
Teclistamab is approved for adult patients with relapsed or refractory multiple myeloma. This means the cancer has either returned after previous treatments (relapsed) or has not responded adequately to prior therapies (refractory). Patients considered for teclistamab have received at least four prior lines of therapy.
These previous treatments must include a proteasome inhibitor, an immunomodulatory agent, and an anti-CD38 monoclonal antibody. Teclistamab is intended for those with advanced disease who have exhausted other treatment options. The effectiveness of teclistamab in this heavily pretreated population has been observed in clinical trials, showing promising response rates.
Managing Side Effects
Treatment with teclistamab can lead to side effects requiring close monitoring. Common reactions include fatigue, fever, nausea, diarrhea, and injection site reactions.
More serious but manageable side effects include Cytokine Release Syndrome (CRS) and Immune Effector Cell-Associated Neurotoxicity Syndrome (ICANS). CRS occurs when activated immune cells release inflammatory proteins, leading to symptoms like fever, chills, low blood pressure, and difficulty breathing. CRS is a common side effect, occurring in about 72% of patients, and is usually mild to moderate in severity. It typically appears within two days of a dose and resolves within a few days.
ICANS involves neurological effects, which can manifest as confusion, headache, motor dysfunction, or speech difficulties. While ICANS is less common than CRS, occurring in about 6% of patients, it can be serious. Both CRS and ICANS are carefully managed with supportive care, including medications like tocilizumab or corticosteroids for CRS, and close observation. Patients are also monitored for infections, as teclistamab can affect the immune system’s ability to fight them.
The Treatment Process
Teclistamab is administered as a subcutaneous injection, meaning it is given under the skin. The treatment begins with a “step-up dosing” approach, where patients receive smaller initial doses before reaching the full therapeutic dose.
The typical step-up schedule involves a first dose of 0.06 mg/kg on Day 1, followed by 0.3 mg/kg on Day 4, and then the first full dose of 1.5 mg/kg on Day 7. This gradual increase helps the body adjust to the medication and reduces the risk and severity of side effects like CRS. For the first few doses, patients are often hospitalized for approximately 48 hours after each step-up dose and the first full dose to allow for close monitoring of potential side effects.
After the initial step-up phase, teclistamab is typically administered weekly at the 1.5 mg/kg dose. Treatment continues until the disease progresses or unacceptable side effects occur. Some patients who achieve a complete response for at least six months may be eligible for a reduced dosing frequency of every two weeks.