Real-world Outcomes with Talquetamab

Real-world Outcomes with Talquetamab

Dysgeusia with talquetamab occurs nearly universally and requires proactive patient counseling about expectations. Unlike many toxicities that may recur with continued dosing, skin and nail changes typically occur once and do not repeat with subsequent cycles. Preventive strategies include nail strengthening products, vitamin E for nail beds, and intensive skin emollients, which help minimize severity though cannot completely prevent these effects.

Taste disturbance management involves dietary modifications and leveraging umami-rich foods or MSG to stimulate taste receptors, which appears to help restore taste sensation over time. Counterintuitively, longer drug exposure with appropriately spaced dosing intervals seems to improve taste rather than worsen it. Initial management includes transitioning to bland, protein-rich diets to minimize weight loss while allowing time for adaptation.

Interval extension based on response represents the primary strategy for managing dysgeusia, with some patients maintained on every-8-week or every-12-week dosing while maintaining responses. Patients who respond do so very quickly, allowing early identification of responders who may tolerate dose de-escalation. One patient, a professional pianist, experienced significant distress from nail and skin changes due to their public-facing profession, though resolution occurred within weeks. Most patients prioritize efficacy over tolerability given the advanced disease setting, but tolerance becomes more important as talquetamab potentially moves into earlier lines where treatment alternatives exist.