In a non-prespecified analysis of data from the international Phase 1/2 MajesTEC-1 trial, patients with relapsed or refractory multiple myeloma who received tocilizumab to treat cytokine release syndrome (CRS) following treatment with the B‐cell maturation antigen x CD3 bispecific antibody teclistimab were less likely than those who did not receive tocilizumab to have a repeat episode of CRS after a subsequent teclistimab dose. The report by Thomas G. Martin, MD, of the University of California, San Francisco, and colleagues was published online in Cancer on March 29.

Tocilizumab reduced the risk of subsequent CRS in patients who received it for their first CRS event (20.0% vs. 62.2% for those not receiving tocilizumab), without affecting the response to teclistamab. Among patients whose CRS was managed with steroids alone, 77.8% experienced one or more subsequent CRS events.

Of 195 CRS events occurring in 119 of 145 patients (72.1%), 50.3% were grade 1, 21.2% grade 2, and 0.6% (one patient) grade 3. CRS occurred most often during the step-up dosing schedule. Fifty-five patients experienced more than one CRS event. Sixty patients (36.4%) were treated with tocilizumab, 14 (8.5%) with steroids, and the remainder with other supportive treatments (e.g., low-flow oxygen, single vasopressor, intravenous fluids, acetaminophen). All CRS events resolved, with or without supportive therapy, and none led to treatment discontinuation.

“Our analysis did not identify any baseline characteristics that were clearly predictive of CRS,” the author wrote. They added that the fact that most CRS events occurred during the step‐up dosing schedule demonstrates “that clinicians need to be vigilant for CRS during initiation of teclistamab.”

• Martin TG, Mateos MV, Nooka A, et al. Detailed overview of incidence and management of cytokine release syndrome observed with teclistamab in the MajesTEC-1 study of patients with relapsed/refractory multiple myeloma [published online ahead of print, 2023 Mar 29]. Cancer. 2023;10.1002/cncr.34756. doi:10.1002/cncr.34756

Tags: study, bispecific t cell engagers, bite, BiTEs, therapies, CRS, bispecific