Advice to Community Oncologists Treating with Bispecifics


Dr Peter Voorhees outlines advice for community oncologists who treat patients with R/R multiple myeloma.

Case: A 63-Year-Old Man with R/R Multiple Myeloma

Clinical Presentation:

Patient AG is a 63 y/o man.

  • PMH: Diabetes, Hypertension
  • SMH: Does not smoke or drink alcohol
  • In October 2018, AG was admitted from clinic with hypercalcemia (Ca 13.7) and anemia (Hb 10.6) after a right pathologic hip fracture.

Clinical Workup and Diagnosis:

  • Calcium: 11.7 mg/dL
  • M-protein, 2.1 g/dL
  • Hemoglobin: 11.2 g/dL
  • Elevated LDH
  • Albumin, 2.7 g/dL
  • SCr, 1.3 mg/dL
  • Bone marrow biopsy confirms 25% clonal plasma cells, FISH del(17p)
  • PET-CT confirms osteolytic bone lesions in both hips; SF diagnosed with IgG kappa multiple myeloma

Disease Relapse and Treatments:

  • AG was initiated on VRd (bortezomib, lenalidomide, and low-dose dexamethasone) in frontline setting
  • He subsequently relapsed and progressed on 3 lines of therapy including belantamab mafodotin
  • He was then enrolled in a clinical trial and started on treatment with the bispecific antibody, talquetamab following four prior lines of therapy
  • Talquetamab was started at a dose of 0.4 mg/kg every week SC

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