Ankit Kansagra, Associate Vice President Oncology Integration and Community Alliance at Tampa General Hospital, Adjunct Professor at UT Southwestern Medical Center, shared a post on X:
“Bispecific in 2L myeloma — New Combinations enters the race Meral Beksac, Rahul Banerjee, Paula Rodriguez-Otero, Thanos Dimopoulos and amazing team of invetigators/sponsor.
MonumenTAL-3, EHA Plenary (Voorhees et al). 1:1:1, n=864: Tal+Dara+Pom (Tal-DP) vs Tal+Dara (Tal-D) vs DPd. ≥1 prior LOT, 85% Len-refractory, 31% high-risk cyto. Median f/u 24.6 mo.
Efficacy vs DPd is dramatic:
- PFS HR 0.28 (Tal-DP) and 0.33 (Tal-D), both p<0.0001
- 24-mo PFS: 81% / 78% / 51%
- ≥CR: 71% / 69% / 35%
- MRD-neg ≥CR (10⁻⁵): 52% / 46% / 16%
- OS HR 0.47 and 0.51 — already significant at interim !!
Tal safety story:
- Gr 3-4 AEs: 97% (Tal-DP) vs 79% (Tal-D)
- Gr 3-4 cytopenias: 88% vs 52%
- Gr 3-4 infections: 37% vs 28%
Pom seems to be causing issues with the marrow reserve. Let’s see where clinical practice lands, Tal-D ??
Some early thoughts
- Median PFS NR in both Tal arms! Impressive.
- Gr 5 AEs were 4.0% Tal-D vs 1.8% Tal-DP. Small N but again as above.
- 11.8% anti-CD38 exposed; similar questions as we had with MajesTEC-3; trials done in era were Dara exposure was not common in NDMM.
- GPRC5D tox- taste changes ~75%, weight loss ~40%, low-grade ataxia ~11%. Discontinuation rates are quite low though.
With MajesTEC-3 already pushing teclistamab plus dara into 2L, bispecifics have officially arrived early. For the typical 2L patient walking into clinic we will have quite a few options.
- Tec-D
- Tal-D
- Tal-DP
- Tec (mono – will see MajesTEC-9)
- Elra mono (Magnetismm-5)
Love the expansion of options for early relapse.”
More posts featuring Ankit Kansagra.