Prevalent Treatment Patterns of Teclistamab and Talquetamab for Multiple Myeloma (MM): Experience from 609 Patients
Authors: Chunara Farheen , Shah Mansi R. , Shah Nishi , Kent Jessica , Mohyuddin Ghulam Rehman , Radhakrishnan Sabarinath V , Kaur Gurbakhash , Chakraborty Rajshekhar , Rasche Leo , Schinke Carolina , D'Souza Anita , Szabo Aniko , Mohan Meera 
Published: December 2024

Introduction: The FDA-approved treatment schedule for teclistamab and talquetamab includes 1.5 mg/kg Q1W, with the option of 1.5 mg/kg Q2W dosing in patients who attain ≥ CR for 6 months, and 0.4 mg/kg Q1W or 0.8 mg/kg Q2W, respectively. However, there is significant interest in exploring alternative dosing schedules to reduce long-term toxicities, specifically infectious complications, and to minimize cost-of-care. In this current study, we examine the prevalent treatment patterns of these two agents in patients with MM.
Methods: The TriNetX dataset was used to identify patients with MM treated with at least one dose of teclistamab or talquetamab. D0 refers to the first step-up dose of the drug, and the first three doses were assumed to be step-up doses. The duration of treatment was evaluated using the Kaplan-Meier estimator from the date of the first dose to the date of the last dose recorded. Treatment was considered completed at the last recorded dose if the patient had a teclistamab or talquetamab-free period of 60 days before the last encounter for any reason, or if the patient died within 60 days from the last dose.
Results: We identified 501 patients who received teclistamab between January 2021 and June 2024. The median age was 70 years (range 31-90). The median duration of teclistamab therapy was 3.9 months (95% CI 2.8-5.0). About 17% of occurrences were initial step-up doses, with the most common step-up dosing schedules being 0-2-4 (41% of patients) and 0-3-6 (15% of patients). In this cohort, the majority (82%) of doses were undergoing ongoing therapy. Among these, 54% of doses were administered weekly (Q1W), 16% every two weeks (Q2W), 2% every three weeks (Q3W), 3% every four weeks (Q4W), and 1% at intervals greater than four weeks (&gt;Q4W). The use of second step-up dosing was rare, accounting for only 0.7% of events. Next, we analyzed the dosing patterns of teclistamab across different treatment intervals from start of treatment such as 7-90 days, 91-180 days, and &gt;180 days. During the first 7-90 days, 83% of doses were administered Q1W, 9.6% Q2W, and less than 1% at Q4W or &gt;Q4W. For the 91-180 day period, the most common dosing schedule was Q1W (61%), followed by Q2W (28%). About 4% and 2.5% of doses were administered at Q4W and &gt;Q4W, respectively. For treatment durations exceeding 180 days, Q2W dosing predominated (44%), with 33% at Q1W intervals. There was also an increase in Q4W dosing to 13%, and nearly 4% of doses were administered at intervals greater than four weeks (&gt;Q4W). The median overall survival (OS) for recipients of teclistamab therapy was 22 months (95% CI 16.3-NR) in this cohort. In addition, 108 recipients of talquetamab treated between September 2023 and June 2024 were included in this analysis. The median age was 66 years (range 34-90). The median duration of talquetamab therapy was not reached (NR). Initial step-up doses accounted for 29% of occurrences, with the most common step-up dosing schedules being 0-2-4 and 0-3-6. Ongoing therapy accounted for 70% of occurrences, with Q2W dosing being most common in 51% of events, followed by Q1W in 18%. Q4W and &gt;Q4W dosing were rare, occurring in 6.5% and less than 1% of events, respectively. Across varying treatment intervals (7-90 days, 91-180 days, and &gt;180 days), the predominant dosing schedule for talquetamab remained Q2W. The median OS was NR in this cohort. Trends in infectious complications with varying dosing schedules of teclistamab and talquetamab are being analyzed and will be presented at the meeting.
Conclusion: The majority of teclistamab doses were administered at Q1W intervals. However, with increasing duration of therapy, alternative dosing patterns such as Q2W, Q4W, and &gt;Q4W schedules were observed in patients treated with teclistamab. Talquetamab was predominantly administered at a Q2W dosing schedule, albeit the shorter follow-up period.