Haematologists.
The most reclusive medical speciality.
Away from the rest of hospital medicine.
Tucked away in dim labs, whispering sweet nothings to bone marrow aspirates.
Once a year, these blood lovers emerge into daylight to discuss all things bloody at theThats right…
A weekend of leukaemias, anaemias, and this year’s best vampire movie (it was unanimously Sinners, by the way).
This year, the study that got all the haematologists' gonads going was the MajestTEC-3 trial published in the
So let me ask you this:
When you think of multiple myeloma(MM), what comes to mind?
Too many plasma cells…
The CRABBI mnemonic…
Maybe rouleaux formation or raindrop skull if you're extra keen...
Management is chemo right? Yes, you’re right!
But MM is a crafty little blood cancer. It just can’t stay down. Relapsing MM is a big concern. And so, when the excess plasma cells return, we give it our full artillery force.
Daratumumab - a CD38 antibody that depletes malignant plasma cells,
+ Dexamethasone - a steroid
+ either Pomalidomide, an immunomodulatory drug or Bortezomib - a proteasome inhibitor.
But even after that, the Myeloma won’t just stay down. The treatment pathway after is a bit convoluted. But the consensus is that if triple therapy doesn’t work, you’re pretty much cooked.
Until now…
This head-to-head trial pits triple therapy against something new – duel therapy. A dual therapy of daratumumab and teclistamab
Teclistamab(tech-li-star-mab) is a fancy antibody that binds to CD3 on T-cells and BCMA on the myeloma cells. Essentially, handholding the condemned cell to its executioner. Thus enhancing cell killing activity.
This study took 587 patients with MM who’d received one to three previous lines of therapy. They were then randomly assigned either:
Standard Care Group(triple therapy) group - 296 patients or
Teclistamab- Daratumumab group - 291 patients.
They continued treatment until progression, unacceptable toxicity, death or withdrawal. The primary endpoint was progression-free survival.
So what did they find?
At a median follow-up of 34.5 months, Teclistamab-Daratumumab absolutely obliterated triple therapy
36 month Progression-Free Survival: 83.4% vs 29.7%
Complete Response: 81.8% vs 32.1%
Overall Response Rate: 89% vs 75.3%
I mean, just look at this graph. A thing of true academic beauty.
Now, Teclistamab isn’t a newcomer. It’s been approved by NICE and the FDA… as a 4th line medication 💀. This staggering finding is sure to have it leapfrog to number 1.
But, maybe not so fast. The side effect profile here is pretty insane:
Serious Adverse Events: Occurred in 70.7% of the teclistamab group vs. 62.4% in the standard group
Infections: Any-grade infections were reported in 96.5% of the teclistamab group. Fatal infections were higher in this group (4.6% vs. 1.4%). 96.5% is crazy icl.
Cytokine Release Syndrome (CRS): This occurred in 60.1% of patients receiving teclistamab, but all cases were low-grade (Grade 1 or 2) and resolved without treatment discontinuation.
So you gotta balance the good with the bad, like all of medicine.
