Prophylactic Tocilizumab and Sequencing Strategies in the Bispecific Era

EP: 1.Setting the Stage and New Milestones in Talquetamab Data

EP: 2.Diving Deeper: Long-Term Safety With Talquetamab

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EP: 3.Prophylactic Tocilizumab and Sequencing Strategies in the Bispecific Era

Prophylactic use of tocilizumab to manage cytokine release syndrome (CRS) during bispecific antibody treatment is currently being evaluated in ongoing clinical trials. Early data suggest that administering tocilizumab prophylactically may significantly reduce the incidence and severity of CRS, particularly during the step-up dosing phase. This step-up dosing traditionally requires prolonged hospital stays, which pose logistical challenges and impact patient quality of life. By reducing CRS severity, prophylactic tocilizumab has the potential to enable outpatient administration of bispecific antibodies, streamlining treatment delivery and improving patient convenience without compromising efficacy.

Clinicians have grown increasingly comfortable managing CRS as they gain experience with T-cell–redirecting therapies. Prompt recognition and early intervention with tocilizumab at the first signs of fever have become standard practice, effectively controlling CRS symptoms and minimizing treatment interruptions. While initial concerns existed that tocilizumab might reduce the effectiveness of these therapies, emerging evidence indicates that early use does not impair response rates. Thus, the integration of CRS management strategies has become an essential component of care, allowing broader patient eligibility and smoother treatment courses.

Another important insight from recent studies is the significance of timing when sequencing different T-cell targeting therapies. Patients who receive a B-cell maturation antigen (BCMA)–targeting treatment such as CAR T-cell therapy often benefit from a treatment-free interval before starting a GPRC5D-targeting bispecific antibody. This break allows T cells to recover and avoid exhaustion, potentially improving the effectiveness of subsequent T-cell engager therapies. In clinical practice, some patients with rapid relapse and high tumor burden may receive chemotherapy and stem cell infusions to replenish immune cells before the next T-cell–directed treatment. These evolving strategies highlight the importance of personalized sequencing and immune system recovery in optimizing multiple myeloma treatment outcomes.