Restarting teclistamab and talquetamab after prolonged dose delay may not require re–step-up dosing

Teclistamab and talquetamab are the first US Food and Drug Administration-approved B-cell maturation antigen CD3 and G protein-coupled receptor, family C, group 5, member D CD3 bispecific antibodies (bsAbs), respectively, for the treatment of triple-class-exposed patients with relapsed/ refractory multiple myeloma after 4 prior lines, based on the pivotal MajesTEC-1 and MonumenTAL-1 studies. 1,2Teclistamab and talquetamab are associated with unique adverse effects (AEs) including cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS).In MajesTEC-1, 72.1% of patients experienced CRS (most grade 1-2 with 1 grade 3 event). 1n the MonumenTAL-1 study, CRS occurred in 77% and 80% of patients who received weekly and biweekly dosing of talquetamab, respectively (most grade 1-2 except for 1 grade 3 event). 3To mitigate CRS and ICANS, the package insert recommends initiating therapy with step-up dosing (SUD), including premedication and inpatient monitoring during the SUD period.