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Evaluating Outpatient Teclistamab Administration in Multiple Myeloma With Robert Rifkin, MD, FACP

At the recent American Society of Hematology (ASH) Annual Meeting, Dr. Robert Rifkin, MD, FACP, a Board-Certified Medical Oncologist and Hematologist at the Rocky Mountain Cancer Centers in Denver, Colorado, sat down with Oncology Data Advisor to discuss his study and presentation on the OPTEC trial, in which administration of the bispecific antibody teclistamab will be evaluated.  

Oncology Data Advisor: Thank you so much for being here with us today, Dr. Robert Rifkin. Would you like to introduce yourself and your research interest?

Robert Rifkin, MD, FACP: Thank you very much for having me. I'm Dr. Rob Rifkin, Medical Oncologist at Rocky Mountain Cancer Centers in Denver, Colorado. We're now part of the Sarah Cannon Research Institute, and we're going to present a poster here that we hope will be a practice-changer in terms of administering bispecific antibodies to multiple myeloma patients.

Oncology Data Advisor: Definitely, and thank you again for being here, we're excited to talk to you about your abstract and your study. Could you give us an overview of OPTEC and what it seeks to study?

Dr. Rifkin: OPTEC will be very interesting because with the advent of bispecific antibodies, there are two really large toxicities that everybody sees—the cytokine release and then the neurotoxicities. In addition, with the particular bispecific—we're studying teclistamab—there's a well-known increased incidence of infections. What we hope to do with this study, which is now in progress, is to take patients, treating them on label, fourth-line myeloma therapy, with the idea of coming up with strategies to decrease cytokine release and to manage infections. In particular, what will make us a little bit unique is that we're going to strike preemptively, if you will, by giving a dose of prophylactic tocilizumab to turn down the cytokine release and then teclistamab according to the label. In addition, as I alluded to, infections are a well-known issue, so part of the secondary end points of this study will be to study the infections and to institute therapy with intravenous immunoglobulin to try and decrease, if not prevent, infections.

Oncology Data Advisor: Speaking of the uniqueness of this study, could you tell me how teclistamab is unique to the rapidly evolving treatment landscape of multiple myeloma?

Dr. Rifkin: Multiple myeloma, every year at ASH there are five new things about it. But really, what's happening now is we know it's an incurable disease. Many years ago we had novel agents, now we have novel therapies, and the newest ones on the block are certainly chimeric antigen receptor (CAR) T cells, which you'll hear a lot about with the B-cell maturation antigen (BCMA) construct and others. In addition, there's a whole host of bispecific antibodies, and the trick for both of them, if you will, is anticipating the toxicities and appropriately managing them. In addition, it may prove important to see what sequence they're given in, but we're just very early on in that process.

Even in this study, which seems brain-dead simple, we need to answer the real question about the cytokine release syndrome (CRS). Can we mitigate it and keep people out of the hospital? Because, as you know, hospital beds are in short supply. Training people properly to manage cytokine release is an endeavor and there's a lot of turnover, as you know, in the hospital system, so it's a huge lift to do all of that, but if we can keep it outside of the hospital and make sure that people don't have to go in for CRS infections and other things, that'll be a huge practice-changer and make us efficiently utilize our resources.

Oncology Data Advisor: Incredible. I wanted to ask you if you wanted to go into a little bit more detail about how this trial in specific is important to further evolving the treatment landscape of multiple myeloma?

Dr. Rifkin: I think the main importance is this is largely a safety study, as we've alluded to, and the idea is to keep people out of hospitals because, as we know right now, everybody is overburdened. Frequently, when patients go to a hospital, they get stuck in the emergency room (ER) and we can't even find them a bed. That's the place where you really don't want people with cytokine release syndrome and other complications, so the idea is to actively try to prevent hospitalization in a proactive way instead of a reflexive way. Reflexive is if you get a toxicity, then you go to the hospital, which may or may not be well-prepared to receive somebody with CRS. The whole idea is, really, to change the practice and shift these very effective therapies to the outpatient setting.

Oncology Data Advisor: Are there any limitations in the study that you're experiencing that you're looking forward to addressing in a future maybe phase 3 trial?

Dr. Rifkin: I don't know that these will ever go to phase 3 because they're so effective, but I think the important issues here are really to tone down the complications, if you will. We're still working out final dosing and intervals, but importantly in this study, we'll be doing extensive pharmacokinetics-pharmacodynamics (PKPD) to make sure that our preemptive intervention with tocilizumab doesn't in any way impair the efficacy of teclistamab, and we'll be, I'm sure, one of the first groups to study that in detail.

Oncology Data Advisor: Awesome. Well, we're so excited to hear more about it in the future. Thank you so much for your time today, Dr. Rifkin.

Dr. Rifkin: Thank you very much.

About Dr. Rifkin

Robert Rifkin, MD, is a Board-Certified Medical Oncologist and Hematologist at the Rocky Mountain Cancer Centers in Denver, Colorado. As well, he is the Medical Director of Biosimilars at McKesson and an Associate Chair of Hematology Research and Disease Lead for Myeloma for The US Oncology Network. Dr. Rifkin specializes in malignant and benign hematology, which includes subspecialties in multiple myeloma, coagulation disorders, and biosimilars.

For More Information

Rifkin R, Sharman JP, Fowler J, et al (2023). Optec: A phase 2 study to evaluate outpatient administration of teclistamab, a BCMA-targeting bispecific antibody, in patients with multiple myeloma. Presented at: 2023 American Society of Hematology ASH Annual Meeting. Abstract 3374. Available at: https://ash.confex.com/ash/2023/webprogram/Paper185257.html

Transcript edited for clarity. Any views expressed above are the speaker's own and do not necessarily reflect those of Oncology Data Advisor. 


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