Adverse Events With Bispecific Therapy: Dysgeusia, Skin, and Nail Changes
Overview of challenges in managing adverse events associated with bispecific therapy in multiple myeloma, including dysgeusia, skin toxicity, and nail changes patients may experience.
Transcript:
Sagar Lonial, MD, FACP: Let’s talk about some of the adverse events…here. You alluded to dysgeusia in your talk. You mentioned a little bit as well from the MonumenTAL[-3] trial. What can we tell people who haven’t used talquetamab regarding the roadmap of what to expect with taste changes as well as some of the other adverse events with talquetamab, particularly the skin and the nail changes?
Cesar Rodriguez, MD: For talquetamab, what was reported was 70% of the patients had skin toxicities and about 60% of the patients had some dysgeusia of some sort. Unfortunately, the way that we have right now classified dysgeusia is not very representative of what the patient is experiencing because the grading of 0 or 1 is dependent. It doesn’t factor in taste loss or the quality of life. And one of the things that we’re noticing is that almost 100% of our patients or 90% of our patients are having a change in their taste. Would you agree?
Donna Catamero, NP: Yes, yes. All patients have some degree of oral toxicity.
Cesar Rodriguez, MD: And it’s just the severity of [whether it’s] impacting their taste completely or is it impacting their taste for savories or for sweets, and then how long it takes for them to recover this taste. And for those who would lose their taste completely, it is a big problem because we are seeing patients lose weight. They’re not wanting to eat. We don’t know exactly why patients are losing taste. We know that GPRC5D is expressed in high-keratinized cells, so the nail beds, the hair follicles, the epididymis and myeloma cells. There isn’t any expression in the taste buds or the saliva glands.
But there are some plasma infiltrates in the saliva glands and maybe this could be a potential factor that could be affecting taste. We had a case where we did a PET scan on this patient that I was talking about and there was uptake in the saliva glands that was not there before they started talquetamab. So based on that now, Donna and the research team are doing some experimental trials on potential ways of trying to prevent this.
Because the way they’re describing it, losing taste or feeling that their mouth is dry or that they’re chewing and when they chew, it becomes harder for them to swallow, it’s very consistent with the decrease in production of saliva. But yet we do know that there is some GPRC5D expression in the tongue; even though it’s not the saliva, the taste buds, it’s next to it, so if there’s some inflammation, it could potentially directly be affecting it. But, Donna, do you want to tell us what the team has been doing?
Donna Catamero, NP: It is a challenging [adverse] effect to manage. We’re trying icing for patients, which can be challenging during the step-up dosing as an inpatient, because we did see that uptake in the glands. We’re trying saliva substitute, icing, dexamethasone and nystatin syrup, zinc oxide as well. And we’re tracking patients, but I think the best way to mitigate these [adverse] effects—patients are responding beautifully to these drugs—is to extend the period. So dose holds and dose reductions, maybe we don’t need to give so frequently, especially if patients are having these nice, durable responses. And as we saw in our clinical experience,…when patients had prolonged dose holds, their taste came back and their response [was] maintained. I think we’re also looking at how we’re giving these drugs.
Transcript is AI-generated and edited for readability.
