The landscape of multiple myeloma treatment is undergoing a transformative shift with the emergence of novel therapies, including the immunotherapy teclistamab. However, the enthusiasm for these groundbreaking treatments is tempered by potential side effects, particularly cytokine release syndrome (CRS), which can be life-threatening.
Physician-scientist Dr. C. Ola Landgren, Chief of the Division of Myeloma at Sylvester Comprehensive Cancer Center, is at the forefront of a study that introduces a proactive strategy to mitigate CRS. Teclistamab, a bispecific T-cell engager, has shown remarkable efficacy in shrinking tumors, but its use is hampered by the risk of CRS, necessitating extended hospital stays for monitoring.
Dr. Landgren’s study, recently published in Blood Cancer Discovery, demonstrates that administering prophylactic treatment, specifically tocilizumab, prior to teclistamab administration, drastically reduces the incidence of CRS. In a cohort of 31 multiple myeloma patients, only 13% developed CRS when treated preventatively, compared to 72% in previous studies treating symptoms as they arose. Furthermore, patients experienced milder CRS and lower recurrence rates.
This breakthrough has significant implications, potentially paving the way for outpatient treatment, eliminating the need for extended hospital stays. Dr. Landgren envisions a paradigm shift, drawing parallels with the evolution of rituximab treatment over two decades ago, which initially required intensive care unit monitoring but is now administered without hospital stays.
The study’s lead author, Andrew Kowalski, emphasizes that the prophylactic approach does not compromise the effectiveness of teclistamab. As the team prepares for future outpatient services, they anticipate expanding the approach to other leukemias and lymphomas.
Dr. Landgren reflects on the remarkable progress in myeloma drug development, marking the beginning of an era dominated by immunotherapy. The findings offer hope for enhanced accessibility and a more patient-friendly approach to multiple myeloma treatment, laying the foundation for the next phase in cancer care.
Source: New England Journal of Medicine, University of Miami
