Real-world experience with talquetamab clinical management in relapsed refractory multiple myeloma (RRMM): A qualitative study of US healthcare providers
P-401: Real-world experience with talquetamab clinical management in relapsed refractory multiple myeloma (RRMM): A qualitative study of US healthcare providers
Introduction: Talquetamab (tal) is the first-in-class GPRC5D x CD3 bispecific antibody for relapsed/refractory multiple myeloma (RRMM), approved in 2023 for QW and Q2W administration. Patients on tal also experience GPRC5D-related on-target off-tumor adverse events (AEs) that may be new to physicians and patients. Given there is limited real-world data on tal, a qualitative study was conducted with US healthcare providers (HCPs) to understand real-world clinical practices associated with dosing and AE management in patients with RRMM.
Methods: Between February and March 2024, 1-hour in-depth interviews (IDIs) (n=10) were conducted with HCPs from academic centers administering tal in both clinical trial and real-world settings. An expert panel (n=6) was conducted after the IDIs to further explore current practices.
Results: Participants had a mean of 10 years’ experience, collectively treating an average of 100 patients with RRMM per month. The IDIs reported a variety of settings for step-up-dosing (SUD), including inpatient (n=5), outpatient (n=3) and hybrid models (n=2). There was a trend toward shorter inpatient stays to reduce healthcare resource utilization, with half of panel participants (n=3) reporting a 7-day average length of stay during SUD. Most of the IDI participants used a Q2W schedule in the SUD (n=7) and treatment phases (n=8). Eight participants indicated they utilized a Q4W schedule in some patients (switching at 2–6 months); factors driving the decision to switch included response, convenience, and GPRC5D-related AEs. Five of the six panel participants’ institutions are developing tal AE management protocols. Mouthwashes/sprays (dexamethasone, dexamethasone+nystatin, Biotène and saliva alternatives), dry mouth lozenges, citrus fruits and sour candy were commonly used to mitigate oral AEs. Prophylactic use of dexamethasone+nystatin liquid 3 times a day at the time of SUD before symptom onset appears promising. The use of an ice wrap around the cheeks 3 times a day every day may be helpful for some patients. In addition, panel participants reported increasing the dose interval from Q2W to Q4W helped alleviate dysgeusia, but dose reduction did not. Other strategies used by the IDI participants included modifying diet or referrals to dieticians (n=6). Topical steroids were used by most (n=7) to mitigate skin AEs such as rashes, as were moisturizers to prevent dryness. Half (n=5) reported using cosmetic products to mitigate nail AEs.
Conclusions: This study outlines current clinical practices for tal. Findings indicate there is variation in the SUD care setting (half as inpatient and half as outpatient/hybrid models). The selection of a Q2W schedule is most common; however, switching to Q4W is a real-world AE management strategy for some patients. The approach to managing GPRC5D-related AEs is evolving. Further RWE is needed to inform the post-response maintenance schedule of tal to maximize durability while mitigating AE impact.