KEY POINTS
While infections and skin toxicities are common with talquetamab, weight loss and oral toxicities are the major adverse events prompting treatment changes or discontinuation due to their marked impact on quality of life.
After achieving response to therapy, adjusting the dose and/or frequency of talquetamab may improve the toxicity profile without compromising efficacy.
ABSTRACT
Talquetamab received accelerated approval for relapsed/refractory multiple myeloma (RRMM) based on the MonumenTAL-1 trial; however, its on-target, off-tumor adverse events (AEs) remain a challenge. We analyzed 51 RRMM patients treated at Memorial Sloan Kettering Cancer Center between August 2023 and October 2024 who received ≥1 full subcutaneous dose of talquetamab. With a median age of 66 years, 94% were triple-class refractory and 71% had received prior T-cell redirecting therapy. Non-hematologic, non-immune-related toxicities (incidence; partial/full recovery rates) included weight loss (69%; 49%), taste changes (69%; 29%), dry mouth (61%; 58%), dysphagia (43%; 73%), rash (20%; 100%), non-rash skin AEs (69%; 54%), and nail-related changes (49%; 32%). Decreases in treatment frequency, intensity, and discontinuation occurred in 18%, 10%, and 8% of patients, respectively. Oral toxicities/weight loss accounted for a majority (72%) of the treatment modification or discontinuation. Notably, 46% of patients who had reduction in treatment frequency or intensity maintained ongoing responses at last follow-up, with numerically higher rates of recovery from weight loss (64% vs. 41%) and taste changes (38% vs. 23%) compared to those who did not. Future studies should optimize talquetamab dosing strategies based on response quality and toxicity profiles.
Author notes
Authors contributed equally
Data sharing statement: Data supporting the findings of this study are available upon reasonable request to the corresponding authors, subject to institutional policies and data privacy regulations.
