Teclistamab Plus Daratumumab Approval Marks Milestone in Myeloma Care: Ajai Chari, MD

Reflecting on the evolution of bispecific antibodies in multiple myeloma, Ajai Chari, MD, professor of medicine and director of the Multiple Myeloma Program at the University of California, San Francisco, offered perspective on what the FDA approval of teclistamab (Tecvayli; Janssen Biotech, Inc) in combination with daratumumab and hyaluronidase-fihj (Darzalex Faspro; Janssen Biotech, Inc) means for patients and community oncologists alike.

Chari recalled practicing in New York during the COVID-19 pandemic, when the original bispecific clinical trials were underway. At the time, patients had exhausted all available therapies, making it feel very uncertain to stop any of them from treatment. “The alternatives were so few,” he said.

Now, with a clearer picture of how powerful these therapies are, the field has shifted its focus to questions of long-term dosing and duration. Chari noted that the Kaplan-Meier curves are notably flat over time, with few relapses seen in the long term.

“The flatness of the Kaplan-Meier curve speaks to the durability of the remissions,” he said, adding that long-term remissions represent a first step toward what he described as functional cures. Overall survival curves, too, are flat in the long term. The primary toxicity concern he flagged for community awareness is infection, which is substantially mitigated with intravenous immunoglobulin.

On the question of community uptake, Chari drew a direct parallel to the early days of monoclonal antibodies. “Bispecifics today are where we were with monoclonals 20 years ago,” he said, recalling that daratumumab and rituximab were once met with hesitation due to infusion-related reactions and long chair times. With 15 bispecifics now FDA-approved in hematology and oncology, he was direct: practices and patients that don’t engage risk getting left behind.

For community sites, Chari outlined key practical considerations around cytokine release syndrome, including whether to use prophylactic or treatment tocilizumab, which is now listed in the National Comprehensive Cancer Network compendium, and whether to manage patients in the inpatient or outpatient setting. Immune effector cell-associated neurotoxicity syndrome, he said, is generally self-limited and not a major concern. Once the learning curve is navigated, bispecifics genuinely belong in the community, he argued.

“Their very benefit is being off the shelf, ready to go, same product for every patient,” Chari said. However, realizing that potential requires community delivery.