Oncology Drug Reference Sheet: Talquetamab-Tgvs

February 27, 2024 by Chelsea Backler MSN, APRN, AGCNS-BC, AOCNS®, VA-BC

This ONS resource was produced for educational purposes only. Refer to the full talquetamab-tgvs (Talvey™) package insert (https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=9001355e-003d-4d4e-b4ce-337e0fd14952) for all details. 

DRUG INFORMATION
Classification Immunotherapy; bispecific T-cell engager/bispecific antibody  
Mechanism of Action Binds to the GPRC5D receptor on multiple myeloma cells and nonmalignant plasma cells and to CD3 on T cells, which results in cytokine release and leads to lysis of multiple myeloma cells
Indication Adults with relapsed or refractory multiple myeloma who have received at least four prior lines of therapy, including a proteasome inhibitor, an immunomodulatory agent, and an anti-CD38 monoclonal antibody
ADMINISTRATION
Dosing, Frequency,
and Duration		 Weekly Dosing
Day Dose
1 Step-up dose 1: 0.01 mg/kg
4 Step-up dose 2: 0.06 mg/kg
7 First treatment dose: 0.4 mg/kg
One week after the first treatment dose and weekly thereafter (minimum of six days between doses) 0.4 mg/kg
Every Two Weeks Dosing
Day Dose
1 Step-up dose 1: 0.01 mg/kg
4 Step-up dose 2: 0.06 mg/kg
7 Step-up dose 3: 0.4 mg/kg
10 First treatment dose: 0.8 mg/kg
Two weeks after the first treatment dose and every two weeks thereafter (minimum of 12 days between doses)  0.8 mg/kg
Route Subcutaneous injection
Safe Handling Talquetamab-tgvs is a potentially hazardous drug per the National Institute for Occupational Safety and Health definition (https://www.usp.org/compounding/general-chapter-hazardous-drugs-handling-healthcare#:~:text=The%20National%20Institute%20for%20Occupational,low%20doses%2C%20genotoxicity%2C%20or%20structure) because of its embryo-fetal toxicity. Follow safe handling precautions (https://www.ons.org/books/chemotherapy-and-immunotherapy-guidelines-and-recommendations-practice-second-edition).
ADVERSE REACTIONS
  • Decreased lymphocytes, neutrophils, white blood cells, and hemoglobin
  • Nail disorders, skin disorders, rash, and xerosis
  • Dry mouth, dysgeusia, dysphagia, diarrhea, and decreased weight
  • Pyrexia, fatigue, musculoskeletal pain, hypotension, and headache
  • Upper respiratory tract infection
  • Cytokine release syndrome (CRS)
WARNINGS
Black box warnings: CRS and neurologic toxicity, including immune effector cell–associated neurotoxicity syndrome (ICANS)
Other warnings: oral toxicity and weight loss, serious infections, cytopenias, skin toxicity, hepatotoxicity, and embryo-fetal toxicity
NURSING CONSIDERATIONS
Pretreatment
  • Verify patients’ pregnancy status and monitor complete blood cell counts, liver enzymes, bilirubin, and weight at baseline and regularly throughout treatment.
  • Administer premedications (corticosteroid, antihistamine, and antipyretic) one to three hours prior to each dose in the step-up dosing schedule
  • Talquetamab-tgvs is available only through a risk evaluation and mitigation strategy (REMS) program (https://tec-talrems.com/#Main); provide patients with a wallet card (https://tec-talrems.com/#Main/Prescribers) at the start of their treatment.
Administration
  • The abdomen is the preferred injection site, but other subcutaneous sites may be used.
  • Divide doses greater than 2 ml equally between multiple syringes and inject them separately at least 2 cm apart.
Post-treatment
  • Skin reactions include rash, maculo-papular rash, erythema, and erythematous rash; conduct regular skin assessments.
  • Oral toxicities include dysgeusia, dry mouth, dysphagia, and stomatitis; refer patients to a dietician depending on severity.
  • In the drug’s clinical trial, 76% of patients developed (https://doi.org/10.1200/JCO.2023.41.16_suppl.8036) CRS; the median time to onset was 27 hours after administration, most commonly after step-up dose 1 or 2.
  • In the clinical trial, 55% of patients developed (https://doi.org/10.1200/JCO.2023.41.16_suppl.8036) neurologic toxicity; the median time to onset of ICANS was 2.5 days after administration.  
  • All step-up doses require hospitalization for 48 hours after administration.
PATIENT EDUCATION
  • Report fever or signs of infection, neurologic symptoms (e.g., dizziness, confusion, changes in consciousness), shortness of breath, jaundice, dark urine, abdominal pain, trouble swallowing, weight loss, mouth sores, skin changes, and loss of appetite.
  • Delayed onset of CRS or ICANS is possible; seek immediate evaluation if you develop symptoms.
  • Avoid pregnancy and breastfeeding during treatment and for four months after your final dose.
  • Refrain from driving and operating heavy or potentially dangerous machinery during and for 48 hours after a step-up dose schedule or until any new-onset neurologic toxicity symptoms resolve.
  • Carry a wallet card at all times and present it to all healthcare providers.
RESOURCES
Patient Resources
Healthcare Professional Resources
Other Resources

Note. Talquetamab-tgvs (Talvey®) and teclistamab-cqyv (Tecvayli®) are lookalike/sound alike drugs. Both are indicated for the treatment of adult patients with relapsed or refractory multiple myeloma but are distinct drugs with different mechanisms of action, dosing, and safety profiles. Consult the package insert for full drug information.

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