Talquetamab is a GPRC5D/CD3 bispecific antibody approved by the U.S. FDA in 2023 for the treatment of relapsed or refractory multiple myeloma.

Important Precautions for the Use of Talquetamab

Indication Confirmation

Talquetamab is indicated for adult patients with relapsed or refractory multiple myeloma who have previously received at least 4 lines of treatment, including proteasome inhibitors, immunomodulatory agents, and anti-CD38 monoclonal antibodies.

This indication was approved under the accelerated approval pathway, and further confirmatory trials are required to verify clinical benefits.

Baseline Examination Requirements

Laboratory tests: Complete blood count, liver function (ALT/AST/bilirubin), and electrolyte levels.

Infection screening: Assessment of active infections, including bacterial, fungal, and viral infections.

Neurological evaluation: Baseline cognitive function and neurological status.

Medication Use in Special Populations

Pregnant women: May cause fetal harm. Contraception should be used during treatment and for 3 months after the last dose.

Lactating women: Breastfeeding is not recommended during treatment and for 3 months after the last dose.

Elderly patients: Caution is required for patients aged 75 years and above, as they may have an increased risk of fatal adverse reactions.

Patients with hepatic or renal impairment: No dose adjustment is needed for mild to moderate renal impairment or mild hepatic impairment; data on patients with severe impairment are limited.

Treatment Monitoring for Talquetamab

Cytokine Release Syndrome (CRS) Monitoring

Main manifestations: Common symptoms include fever (83%), hypotension (21%), and hypoxia (11%).

Graded management:

Grade 1: Temporarily discontinue administration until symptoms resolve.

Grade ≥2: Hospitalize for 48-hour monitoring; administer tocilizumab/glucocorticoids if necessary.

Neurotoxicity Monitoring

ICANS (incidence: 9%): Changes in consciousness, disorientation, and language impairment.

Other neurotoxicities: Peripheral neuropathy (14%), headache (21%), and tremor (11%).

Management requirements: Immediately discontinue administration if symptoms occur, and consider neurological consultation.

Oral Toxicity Monitoring

Common manifestations: Taste disturbance (49%), xerostomia (dry mouth, 34%), and dysphagia (difficulty swallowing, 23%).

Weight monitoring: 62% of patients experience weight loss, with 29% having a weight loss of ≥10%.

Intervention measures: Provide nutritional support and symptom management; temporarily discontinue administration in severe cases.