Teclistamab is a B-cell maturation antigen (BCMA) that targets bispecific T-cell engagers. Approved by the US Food and Drug Administration based on data from the MajesTEC-1 trial, it is used to treat patients with relapsed/refractory multiple myeloma (RRMM) who have received at least four prior lines of therapy (LOT). In a multicenter retrospective study presented at the 2023 ASH Annual Meeting & Exposition, Danai Dima, MD, Taussig Cancer Institute, Cleveland Clinic, and colleagues examined the real-world safety and efficacy of teclistamab.

The researchers used data from five academic centers that are part of the US Myeloma Innovations Research Collaborative. Participants in the study included 102 patients with RRMM who had been treated with teclistamab as of July 1, 2023, with 55% being refractory before receiving BCMA-directed therapy (BDT). For the study, patients received at least two step-up doses of teclistamab and then one full dose.

All of the patients had triple class exposed (TCE) RRMM, 92% had triple class refractory (TCR) RRMM, 78% had penta exposed (PE) RRMM, and 67% had penta refractory (PR) RRMM. Of the cohort, 25% of the patients were non-Hispanic Black and 44% had extramedullary disease (EMD). From a range of 4-17 prior LOT, they had a median of 6 prior LOT. In addition, more than 80% (83/102) of the participants would not have been eligible for the MajesTEC-1 trial due to prior BDT (55%), ECOG performance status ≥2 (28%), and baseline cytopenias: grade 3-4 anemia (26%), and grade 3-4 thrombocytopenia (20%).

For the full cohort of patients, the overall response rate (ORR) was 64% after a median follow up of 3.2 months. They also had a very good partial response rate of ≥72% and a complete response or better rate of ≥45%. Patients who were refractory prior to BDT had an ORR of 57%, those with penta refractory MM had an ORR of 66%, and those with EMD had an ORR of 45%. The ORR was 59% for patients that would not have been eligible for the MajesTEC-1 trial.

The rates of progression-free survival at the 6-month mark for the entire cohort was 38% (95% CI, 26-56). The 6-month rates for duration of response (DOR) and overall survival (OS) were 54% (95% CI, 34-85) and 68% (95% CI, 58-80), respectively, for the whole cohort. The percentage of patients who had died at the data cut-off period was 26%, with 89% of the deaths attributed to disease progression.

Overall, the patient group responded well to receiving teclistamab. There were only minor safety concerns and there were no findings of treatment mortality. “Despite the increased incidence of high-risk features, including penta-refractoriness, BDT refractoriness, and presence of EMD in this heavily pre-treated RRMM patient population, early efficacy assessment of teclistamab in a real-world setting was encouraging,” said Dr Dima and colleagues.

Source: Dima D, Davis JA, Ahmed N, et al. Real-world safety and efficacy of teclistamab for patients with heavily pretreated relapsed-refractory multiple myeloma. Presented at: 2023 ASH Annual Meeting & Exposition; December 9-12, 2023; San Diego, CA, and virtual; Abstract 91.