Case-Based Peer Perspectives: A 72-Year-Old Man With Relapsed/Refractory Multiple Myeloma (RRMM)

Panelist discusses the clinical patient, a 72-year-old man who was previously diagnosed 6 years ago with multiple myeloma, 60% plasma cells, which he presents to his oncologist after 5 prior treatment regimens. The patient also has had 2 episodes of pneumonia and multiple episodes of bronchitis over the prior 10 years.

Panelist discusses how the RRMM treatment landscape has evolved significantly, with BiTEs emerging as a promising approach. BCMA-targeted BiTEs showed efficacy, while GPRC5D-targeting agents like talquetamab represent promising new options, particularly for patients with BCMA-refractory disease. Key challenges include managing cytokine release syndrome, developing optimal sequencing strategies, addressing drug resistance, and improving accessibility and affordability of novel therapies.

Panelist discusses how the MonumenTAL-1 study led to the approval of talquetamab in patients with 4 or more prior lines of therapy, and the initial response rate was 70%. There were also several toxicities associated with MonumenTAL-1, including oral, nail, and skin toxicities.

Panelist discusses how talquetamab’s step-up dosing strategy aims to mitigate cytokine release syndrome, a common immunologic toxicity. The reported grade 1 CRS with altered taste and dry mouth represents a mild manifestation compared with the MonumenTAL-1 trial, where the initial SUD schedule showed varying CRS rates. Real-world evidence has largely validated trial findings, though alternative SUD approaches may offer different risk-benefit profiles. The optimal SUD strategy continues to evolve as clinical experience expands, balancing efficacy with tolerability.