Talquetamab: Real-World Outcomes With Outpatient Dosing
Panelists discuss how real-world outpatient talquetamab data from Mayo Clinic show that 85% of patients can start treatment as outpatients with about 50% completing the entire step-up process without hospitalization, while different centers are developing varying approaches to cytokine release syndrome (CRS) management—from no prophylaxis with 50% admission rates to prophylactic tocilizumab with 3% admission rates—suggesting that practice preferences may ultimately determine which bispecific agents are favored based on factors like median time to CRS onset.
Talquetamab Real-World Outcomes With Outpatient Dosing
A Mayo Clinic study demonstrated the feasibility of outpatient administration of talquetamab in 28 heavily pretreated patients with a median of 8 prior lines of therapy. The study population was representative of real-world patients, with two-thirds having prior B-cell maturation antigen exposure, 40% with prior chimeric antigen receptor T-cell therapy, and about one-third with prior bispecific treatment. Results showed that 85% of patients could initiate treatment in the outpatient setting, with 50% completing the entire step-up dosing process as outpatients. Approximately 48% started outpatient but required some inpatient time during the process, whereas only 1 patient required complete inpatient management throughout the step-up period.
The outpatient approach appears to significantly reduce hospitalization burden, with average inpatient stays of only 4 days when admission was necessary. Different centers have developed varying strategies for managing CRS, ranging from no prophylaxis with 50% admission rates to prophylactic tocilizumab approaches yielding admission rates as low as 3%. Some centers have successfully managed grade 1 CRS in the outpatient setting, which has further reduced admission requirements and shortened hospital stays when they do occur.
The diversity in management approaches reflects the adaptability needed for different practice settings and institutional capabilities. Important considerations include the timing characteristics of CRS, which vary among bispecific antibodies. Talquetamab has the shortest median time to CRS onset and duration (approximately 10-11 hours), compared with about 2 days for other bispecifics. This timing difference may influence institutional preferences and management strategies. The recent NCCN guideline recommendation for prophylactic tocilizumab across all bispecific antibodies represents an important standardization step that should facilitate broader community adoption. The variety of successful approaches suggests that institutions can tailor their protocols based on their specific capabilities and patient populations while maintaining safety and efficacy.
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