A single tocilizumab dose prior to initiation of teclistamab therapy effectively reduced the incidence of cytokine release syndrome (CRS) in patients with relapsed or refractory multiple myeloma (MM), according to longer-term follow-up data presented at the Society of Hematologic Oncology 2024 Annual Meeting.
Lead author and presenter, Niels WCJ van de Donk, PhD, MD, of the Amsterdam University Medical Center, stated that tocilizumab prophylaxis yielded a 65% relative reduction in the incidence of CRS during teclistamab therapy compared with the overall MajesTEC-1 cohort.
The incidence of grade 1 and grade 2 CRS was 8% and 17% in the tocilizumab cohort compared with 50% and 21% in the overall cohort, respectively.
The longer-term analysis included 24 patients with a median follow-up of 8.1 months (range, 0.9-13.2). The group had a median age of 72 years (range, 50-82) and a median of four prior lines of therapy (range, 2-9).
Additionally, all patients had an Eastern Cooperative Oncology Group Performance Score of one or lower, 96% were International Staging System I or II, 74% had standard-risk cytogenetics, 21% had extramedullary plasmacytomas, and 33% had 30% or greater bone marrow plasma cells.
The authors reported CRS in six patients (25%), of which two had grade 1 and four had grade 2. Three of these patients each had one recurrence of CRS. The median time to CRS was two days (range, 1-3) and the median duration of CRS was two days (range, 2-4). The CRS events were treated with additional tocilizumab (n=5) and steroids (n=1), and all were resolved without teclistamab discontinuation.
The most common adverse events were infections (any grade, 79%; grade 3-4, 25%), neutropenia (any grade, 63%; grade 3-4, 63%), and anemia (any grade, 58%; grade 3-4, 25%). Five patients experienced grade 1 or 2 neurotoxicity.
Overall, the researchers observed no new safety signals or any impact on teclistamab response in patients who received tocilizumab prophylaxis.
“Prophylactic tocilizumab may be a useful measure to consider when selecting patients for outpatient administration of teclistamab,” Dr. van de Donk concluded.
Reference
van de Donk NW, Garfall AL, Benboubker L, et al. Longer-term follow-up of patients receiving prophylactic tocilizumab for the reduction of cytokine release syndrome (CRS) in the phase ½ MajesTEC-1 study of teclistamab in relapsed/refractory multiple myeloma (RRMM). Abstract #MM-344. Presented at the Society of Hematologic Oncology 2024 Annual Meeting; September 4-7, 2024; Houston, Texas.