Advice to Community Oncologists Treating with Bispecifics
Dr Peter Voorhees outlines advice for community oncologists who treat patients with R/R multiple myeloma.
Case: A 63-Year-Old Man with R/R Multiple Myeloma
Clinical Presentation:
Patient AG is a 63 y/o man.
- PMH: Diabetes, Hypertension
- SMH: Does not smoke or drink alcohol
- In October 2018, AG was admitted from clinic with hypercalcemia (Ca 13.7) and anemia (Hb 10.6) after a right pathologic hip fracture.
Clinical Workup and Diagnosis:
- Calcium: 11.7 mg/dL
- M-protein, 2.1 g/dL
- Hemoglobin: 11.2 g/dL
- Elevated LDH
- Albumin, 2.7 g/dL
- SCr, 1.3 mg/dL
- Bone marrow biopsy confirms 25% clonal plasma cells, FISH del(17p)
- PET-CT confirms osteolytic bone lesions in both hips; SF diagnosed with IgG kappa multiple myeloma
Disease Relapse and Treatments:
- AG was initiated on VRd (bortezomib, lenalidomide, and low-dose dexamethasone) in frontline setting
- He subsequently relapsed and progressed on 3 lines of therapy including belantamab mafodotin
- He was then enrolled in a clinical trial and started on treatment with the bispecific antibody, talquetamab following four prior lines of therapy
- Talquetamab was started at a dose of 0.4 mg/kg every week SC
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