How to manage toxicities associated with bispecific antibody therapy for MM in community practice

The Multiple Myeloma Hub spoke with María-Victoria Mateos, University Hospital of Salamanca, ES. We asked about the management of toxicities associated with bispecific antibody therapy for multiple myeloma (MM) in community practice.  

In this interview, Mateos discusses practical considerations for the management of adverse events (AEs) associated with bispecific antibodies in MM. Mateos outlines how to recognize and manage cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS), as well as strategies to mitigate infection risk. Mateos also discusses the management of skin, nail, and oral toxicities associated with G-protein coupled receptor family C group 5 member D (GPRC5D)-directed bispecific antibodies.

Key points 

• CRS is a common adverse event associated with bispecific antibody therapy and typically occurs following the first or second step-up dose.^1,2 
• Prophylactic tocilizumab may be considered, where available, to mitigate CRS.¹ 
• ICANS occurs less frequently than CRS, and patients, caregivers, and healthcare professionals should be aware of neurological symptoms that may occur around the time of CRS.¹ 
• Neurological assessment and appropriate grading are important when ICANS is suspected, with corticosteroids often used for management.¹ 
• Infection risk is an important consideration with bispecific antibody therapy, particularly with B-cell maturation antigen (BCMA)-directed options.¹ 
• Preventive strategies include ensuring vaccinations are up to date where possible before treatment and providing antiviral and Pneumocystis jirovecii pneumonia prophylaxis.¹ 
• Intravenous or subcutaneous immunoglobulin (Ig) replacement may be considered as primary prophylaxis to mitigate infection risk where appropriate.¹ 
• Patients should be monitored for opportunistic infections.¹ 
• Granulocyte colony-stimulating factor may be used to manage neutropenia occurring during bispecific antibody therapy.¹ 
• GPRC5D-targeted bispecific antibodies are associated with on-target, off-tumor toxicities, including skin, nail, and oral toxicities.³ 
• Patient education is important for the management of GPRC5D-associated toxicities, with adequate hydration recommended to support the management of skin and nail abnormalities.³ 
• Supportive measures for oral toxicity include adequate hydration, nutritional support, artificial saliva, and small bites and sips with meals.³ 
• Early recognition and appropriate management of adverse events, alongside preventive and supportive care strategies, are important when delivering bispecific antibody therapy in community practice. 

This educational resource is independently supported by Johnson & Johnson. All content is developed by SES in collaboration with an expert steering committee. Funders are allowed no influence.