NSO-01: The real world experience of the incidence, assessment, and management of oral adverse events and weight loss with talquetamab leading to the development of an assessment tool
Nurse Practitioner Mount Sinai Hospital Jersey City, New Jersey, United States
Introduction: Talquetamab is a T-cell redirecting bispecific antibody that targets a novel antigen, GPRC5D, on myeloma cells and CD3 on T cells. Data from the MonumenTAL-1 study in patients with relapsed/refractory multiple myeloma (RRMM) support efficacy of talquetamab with overall response rates >71%. Talquetamab is associated with a distinct group of GPRC5D-related adverse events (AEs) including oral AEs (dysguesia, dysphagia, and dry mouth). Oral AEs can limit a patient’s intake and lead to weight loss. These particular AEs can greatly effect a patient’s quality of life and treatment adherence. Here we aim to describe the real world experience (RWE) of the incidence, presentation, and management of oral AEs and weight loss in patients receiving talquetamab.
Methods: This retrospective study analyzed data from all RRMM patients who were treated with commercial talquetamab at our center beginning August 31, 2023. Patients who received talquetamab as a part their therapy were identified through the pharmacy’s database. Data was abstracted from electronic medical records and data on treatment administration, disease profiles, and toxicities were collected.
Results: As of May 25, 2024, data from 47 patients was analyzed. Patient race consisted of 47% White, 38% Black and Hispanic, and 4% Asian. Overall, 100% of patients experienced at least one oral toxicity. Among patients with oral toxicity, 98% of patients experienced any grade dysguesia, 61% dry mouth, and 11% dysphasia. One patient discontinued treatment due to oral AEs. Out of the patients who completed at least 3 cycles (N23), 57% of patients had any grade weight decrease of which 69% were grade 1 and 23% were grade 2. Management of oral AEs consisted of dexamethasone/nystatin swish and spit three times a day, artificial saliva, and nutritional consultation for weight management.
Conclusions: Our RWE from a heterogeneous patient population demonstrates a higher incidence of dysgeusia and weight loss than the MonumenTAL-1 study. Grading the severity of oral AEs was a limitation in this study due to inconsistencies in documentation across practitioners and a lack of a standardize assessment tool for dysgeusia. Based on symptoms observed in our practice we have developed the Sinai dysgeusia evaluation tool (SiDET) that can identify the impact of dysgeusia and can be applied to evaluate the effectiveness of interventions for dysgeusia and determine if dose adjustments are warranted. Understanding real word incidence of oral toxicities is needed for practical guidance in patient education and symptom management to ensure successful administration and adherence of talquetamab.