(PA-023) Outcomes of Teclistamab (Tec) Step-up Dosing in Outpatient/hybrid Settings Among a Large Sample of Relapsed Refractory Multiple Myeloma (RRMM) Patients Treated with Tec

Introduction: Tec is a first-in-class BCMA x CD3 bispecific antibody approved for the treatment of RRMM and is initiated using step-up dosing (SUD). In clinical practice, Tec SUD is shifting towards outpatient (OP) or hybrid (HY) initiation, although real-world (RW) evidence on Tec has been largely limited to academic centers with SUD conducted primarily in inpatient settings. To address these gaps, clinical outcomes of Tec patients (pts) were assessed in a large, multi-center data predominantly from US community practices and in a subgroup of pts who received Tec in OP/HY settings during SUD.

Methods:

This was a retrospective, multicenter chart review study. Data were extracted from electronic medical charts of eligible pts from a large oncology provider network. Adult pts with RRMM initiating Tec since FDA approval (10/25/22) were included. Characteristics and treatment history were captured during the baseline period; cytokine release syndrome (CRS), immune effector cell-associated neurotoxicity syndrome (ICANS), and infections were captured during the treatment period; and clinical outcomes were captured during the follow-up period. Variables were analyzed in all included pts and in a subgroup of OP/HY pts (i.e., who completed SUD fully in OP setting or had ≥1 SUD dose in the OP setting).

Results:

The overall cohort and OP/HY SUD subgroup included 222 and 71 pts (29 OP, 42 HY), respectively, with 66% of all pts treated by community providers. The overall cohort had a median age of 68 years, with 60% male, 75% White and 19% Black (OP/HY SUD: median age 63 years, 61% male, 78% White and 18% Black). At Tec initiation, 37% of the overall cohort had R-ISS stage III disease (OP/HY: 27%), 77% had an ECOG score of 0-1 (OP/HY: 78%), 38% had high-risk cytogenetics (OP/HY: 42%), and 95% were triple-class exposed (OP/HY: 93%). Median prior lines of therapy were 4 in both the overall cohort and OP/HY subgroup. During SUD, CRS occurred in 33% (highest grade (G) 1: 21%, G2: 10%, G3: 2%) of all pts and 27% (G1: 16%, G2: 9%, G3: 3%) of OP/HY pts; ICANS occurred in 5% (highest G1: 3%, G2: 2%, G4: 1%) of all pts and 4% (G1: 3%, G2: 1%) of OP/HY pts. Primary prophylaxis for infections was administered to 81% of all pts and 72% of OP/HY pts. At a median follow-up of 5.4 months, infections occurred in 15% (highest G1: 6%, G2: 7%, G3: 1%, G5: 1%) of all pts and 18% (G1: 9%, G2: 6%, G3: 3%, G5: 1%) of OP/HY pts during Tec treatment. Treatment discontinuations due to CRS, ICANS and infections occurred in 2%, 1%, and 2% of all pts, respectively. The overall response rate (ORR) was 70% in all pts and 78% in OP/HY pts.

Conclusions:

In this RW study of pts treated with Tec in primarily community settings, safety (CRS, ICANS, infections) and effectiveness (ORR) outcomes appeared comparable between pts receiving Tec SUD in OP/HY settings and the overall cohort, demonstrating that it is feasible to administer Tec SUD in OP/HY settings with focus on appropriate prophylaxis and management.