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TECVAYLI - Occurrence and Management of Hematologic Events

Last Updated: 02/13/2025

SUMMARY

  • Janssen does not recommend the use of TECVAYLI in a manner inconsistent with the approved labeling.
  • Hematologic adverse events (AEs) have been reported in the MajesTEC-1, MajesTEC-2, MajesTEC-4, MajesTEC-5, MajesTEC-7, RedirecTT-1, and TRIMM-2 studies.1-14
  • MajesTEC-1 (MMY1001) is a phase 1/2, multicohort study evaluating the safety and efficacy of TECVAYLI in patients with relapsed or refractory multiple myeloma (RRMM).1-4,15-17
    • Cohort A (triple-class exposed) included 165 patients who were previously treated with a proteasome inhibitor (PI), an immunomodulatory agent, and an anti-CD38 monoclonal antibody.1
      • Nooka et al (2023)18,19 published the incidence, timing, and management of neutropenia in patients receiving TECVAYLI in the MajesTEC-1 study. At a median follow-up of 22.8 months, grade 3/4 neutropenia was reported in 65.5% of patients and grade 3/4 febrile neutropenia was reported in 3.6% of patients.
      • Garfall et al (2024)17 presented the incidence of hematologic treatment-emergent adverse events (TEAEs) at a longer-term median follow-up of 30.4 months. Grade 3/4 hematologic TEAEs included neutropenia (65.5%), anemia (37.6%), lymphopenia (34.5%), thrombocytopenia (23.0%), and leukopenia (9.1%).
    • Cohort C included 40 patients, previously treated with a PI, an immunomodulatory agent, an anti-CD38 monoclonal antibody and anti-B-cell maturation antigen (BCMA)-targeted therapies.3,20
      • Touzeau et al (2024)20 published the incidence of hematologic AEs at a median follow-up of 28.0 months. Grade 3/4 hematologic AEs included neutropenia (65%), lymphopenia (42.5%), anemia (35%), and thrombocytopenia (30.0%).
    • The prophylactic tocilizumab cohort is evaluating the administration of intravenous (IV) tocilizumab (8 mg/kg) prior to TECVAYLI dosing for the reduction of cytokine release syndrome (CRS) in 24 patients with RRMM.4,21
      • van de Donk et al (2024)21 presented the incidence of hematologic TEAEs at a median follow-up of8.1 months. Grade 3/4 hematologic TEAEs included neutropenia (62.5%), lymphopenia (37.5%), anemia (25.0%), thrombocytopenia (25.0%), and leukopenia (20.8%).
    • Miao et al (2023)22 presented the analysis of exposure/safety relationships of TECVAYLI in patients with RRMM in the MajesTEC-1 study for the occurrence of select grade ≥3 TEAEs including anemia, neutropenia, lymphopenia, and thrombocytopenia.
    • Per protocol: Dose interruption was the primary method for managing AEs in the MajesTEC-1 Study. Please see below for a summary of permitted medications, mitigation strategies and dose interruption strategies from the MajesTEC-1 protocol for the management of hematologic AEs.23,24
  • MajesTEC-2 (MMY1004) is an ongoing, phase 1b, multicohort study evaluating the safety and efficacy of TECVAYLI in combination with other anticancer therapies in patients with multiple myeloma (MM).5-7,12,25
    • Cohort A included 17 patients with RRMM who received TECVAYLI in combination with DARZALEX FASPRO® (daratumumab and hyaluronidase) and pomalidomide.12
      • D’Souza et al (2024)12 presented the incidence of hematologic AEs at a median follow-up of 16.2 months. The most common grade 3/4 hematologic AEs included neutropenia (88.2%), anemia (23.5%), and lymphopenia (17.6%).
    • Cohort C included 28 patients who received TECVAYLI and nirogacestat.5
      • Offner et al (2023)5 presented the incidence of hematologic AEs at a median follow-up of 14.7 months. The most common grade 3/4 hematologic AEs included neutropenia (75.0%), anemia (32.1%), and thrombocytopenia (14.3%).
    • Cohort D included 31 patients with MM who received TECVAYLI in combination with lenalidomide (Tec-Len).6
      • Tan et al (2023)6 presented the incidence of hematologic AEs at a median follow-up of 10.8 months. Grade 3/4 hematologic AEs included neutropenia (67.7%), anemia (19.4%), and thrombocytopenia (16.1%).
    • Cohort E included 32 patients with RRMM who received TECVAYLI in combination with DARZALEX FASPRO and lenalidomide (Tec-DR).7
      • Searle et al (2022)7 presented the incidence of hematologic AEs at a median follow-up of 8.4 months. Grade 3/4 hematologic AEs (≥10%) included neutropenia (78.1%), thrombocytopenia (15.6%), anemia (12.5%), febrile neutropenia (12.5%), and lymphopenia (12.5%).
  • MajesTEC-4 (EMN30; MMY3003) is an open-label, randomized, multicenter, phase 3 study assessing the safety and efficacy of Tec-Len and TECVAYLI alone vs lenalidomide alone as maintenance therapy after an autologous stem cell transplant (ASCT) in patients with newly diagnosed multiple myeloma (NDMM).11,26
    • Zamagni et al (2024)11 presented the incidence of hematologic AEs from a safety run-in (SRI) consisting of 3 cohorts.
      • Cohort 1 (Tec-Len; TECVAYLI weekly [QW] to once every 4 weeks [Q4W]; N=32): At a median follow-up of 21.1 months, the most common grade 3/4 hematologic AEs included neutropenia (93.8%), leukopenia (9.4%), and febrile neutropenia (9.4%).
      • Cohort 2 (Tec-Len; TECVAYLI Q4W; N=32): At a median follow-up of 9.2 months, the most common grade 3/4 hematologic AEs included neutropenia (62.5%), lymphopenia (12.5%), and febrile neutropenia (9.4%).
      • Cohort 3 (TECVAYLI Q4W; N=30): At a median follow-up of 9.2 months, grade 3/4 hematologic AEs included neutropenia (46.7%), lymphopenia (13.3%), and leukopenia (3.3%).
  • MajesTEC-5 (GMMG-HD10; DSMM-XX; MMY2003) is an open-label, nonrandomized, phase 2 study assessing the safety and efficacy of TECVAYLI- and TALVEY® (talquetamab-tgvs)-based combination regimens in patients with transplant-eligible newly diagnosed multiple myeloma (TE-NDMM).13,27
    • Raab et al (2024)13 presented the incidence of hematologic AEs from 3 induction cohorts of the MajesTEC-5 study.
      • Arm A (Tec [QW]-DR; n=10): The most common grade 3/4 hematologic AEs included lymphopenia (70%), neutropenia (30%), and leukopenia (20%).
      • Arm A1 (Tec [Q4W]-DR; n=20): The most common grade 3/4 hematologic AEs included neutropenia (65%), lymphopenia (35%), and anemia (20%).
      • Arm B (TECVAYLI Q4W in combination with DARZALEX FASPRO, bortezomib, and lenalidomide; Tec [Q4W]-DVR; n=19): The most common grade 3/4 hematologic AEs included neutropenia (63.2%), lymphopenia (36.8%), and leukopenia (26.3%).
  • MajesTEC-7 (MMY3005) is a randomized, phase 3, open-label, multicenter study evaluating the safety and efficacy of Tec-DR and TALVEY in combination with DARZALEX FASPRO and lenalidomide (Tal-DR) vs DARZALEX FASPRO in combination with lenalidomide and dexamethasone (DRd) in patients with NDMM who are ineligible or not intended for transplant as initial therapy.10,28
    • Touzeau et al (2024)28 presented the incidence of hematologic AEs from SRI Cohort 1 (Tec-DR) at a median follow-up of 13.8 months. Grade 3/4 hematologic TEAEs were reported in 65.4% of patients overall and included neutropenia (57.7%), thrombocytopenia (15.4%), febrile neutropenia (11.5%), and anemia (3.8%).
  • RedirecTT-1 (MMY1003) is an ongoing, open-label, phase 1b/2 study evaluating the safety and efficacy of TALVEY and TECVAYLI combination in patients with RRMM.8,14,29,30
    • Cohen et al (2025)14 published the incidence of hematologic AEs from the phase 1 dose-escalation segment of the RedirecTT-1 study.
      • All dose levels (dose levels 1-5; N=94): At a median follow-up of 20.3 months, grade 3/4 hematologic AEs included neutropenia (68%), anemia (38%), and thrombocytopenia (30%).
  • TRIMM-2 (MMY1002) is an ongoing, phase 1b, multicohort study evaluating the safety and efficacy of DARZALEX FASPRO regimens in combination with bispecific T-cell redirecting antibodies in patients with RRMM.9,12,31
    • D’Souza et al (2024)12 presented the incidence of hematologic AEs in the TECVAYLI + DARZALEX FASPRO + pomalidomide cohort (N=10) at a median follow-up of 38.3 months. The most common grade 3/4 hematologic AEs included neutropenia (60%), lymphopenia (30%), thrombocytopenia (20%), and febrile neutropenia (20%).
    • Rodriguez-Otero et al (2022)9 presented the incidence of hematologic AEs in the TECVAYLI and DARZALEX FASPRO cohort (N=65) at a median follow-up of 8.6 months. Grade 3/4 hematologic AEs included neutropenia (41.5%), anemia (27.7%), and thrombocytopenia (24.6%).

PRODUCT LABELING

clinical data - majestec-1 study

MajesTEC-1 (MMY1001; clinicaltrials.gov identifiers: NCT03145181; NCT04557098) is evaluating the safety and efficacy of TECVAYLI in patients with RRMM.1,2,4,15-17,20

Study Design/Methods

The main objectives are as follows: Part 1 (dose escalation) to determine the recommended phase 2 dose (RP2D) for TECVAYLI; Part 2 (dose expansion) to distinguish safety and tolerability of TECVAYLI at the RP2D; Part 3 (the phase 2 component) to evaluate the safety and efficacy of TECVAYLI at the RP2D.1,24

  • Key eligibility criteria:
    • Cohort A: ≥3 prior lines of therapy (LOTs) including a PI, an immunomodulatory drug, and an anti-CD38 monoclonal antibody, no prior BCMA-targeted therapy use.1,2
    • Cohort C: ≥3 prior LOTs, a prior PI, an immunomodulatory drug, and an anti-CD38 monoclonal antibody, enrolled patients who had prior exposure to BCMA-targeted treatment (chimeric antigen receptor T-cell [CAR-T] therapy and/or antibody drug conjugate [ADC]).3
    • Prophylactic tocilizumab cohort: ≥3 prior LOTs including a PI, an immunomodulatory drug, and an anti-CD38 monoclonal antibody.4
  • Primary endpoint for Cohort A and Cohort C: overall response rate (ORR).1-3
  • Key secondary endpoint for Cohort A and Cohort C: safety.1-3
  • Endpoint for prophylactic tocilizumab cohort: incidence of CRS.4

MajesTEC-1 Study Protocol - Key Permitted Medications Related to Hematologic AEs

  • Patients were to receive full supportive care during the study.23 The following are examples of supportive therapies related to hematologic events that may have been used during the study:
    • Growth factor support, erythropoietin-stimulating agents, and transfusions were permitted to treat symptoms or signs of neutropenia, anemia, or thrombocytopenia according to local standards of care; these agents were not allowed as prophylactic treatment during the dose-limiting toxicity (DLT) period in Part 1.23
    • Growth factor support should have been avoided during step-up doses, during the first treatment dose and during CRS. Granulocyte-colony stimulating factor (G-CSF) should have been considered for grade 3 neutropenia with infection or fever or any-grade 4 neutropenia.23

MajesTEC-1 Study Protocol - Potential Risks Associated with TECVAYLI and Mitigation Strategies for Cytopenias

  • Mitigation strategies for risk of cytopenias included: Frequent monitoring of hematological parameters and supportive care (eg, transfusions) per institutional standards. Prolonged neutropenia may increase the risk of infection. Severe thrombocytopenia may increase the risk of bleeding.23

MajesTEC-1 Study Protocol (Parts 1, 2, and 3) - Dose Interruption

  • Dose interruption was the primary method for management of AEs. Schedule changes to less frequent dosing could be used for management of recurrent/persistent AEs with sponsor approval.23
  • Select criteria for a dose interruption in Parts 1, 2, and 3 related to hematologic events were24:
    • Grade 4 hematologic toxicity except lymphopenia.
    • Grade 3 thrombocytopenia with bleeding.
    • Febrile neutropenia.
    • Grade 3 neutropenia with infection.

Cohort A Safety Results

Nooka et al (2023)18,19 published the incidence, timing, and management of neutropenia in patients receiving TECVAYLI in the MajesTEC-1 study, based on a data cutoff date of January 4, 2023.

  • Neutropenia was reported in 71.5% of patients overall with grade 3/4 neutropenia reported in 65.5% of patients. Febrile neutropenia was reported in 4.8% of patients (n=8) with grade 3/4 febrile neutropenia reported in 3.6% of patients (n=6).18
  • No patients discontinued TECVAYLI treatment due to neutropenia.18
  • The median time to onset of grade ≥3 neutropenia or febrile neutropenia was 2.3 months (range, 0.0-18.1). Within 2-4 months following TECVAYLI initiation, neutropenia was reported most frequently during this time period compared with other time points. See Table: MajesTEC-1 Study (Cohort A): Occurrence of Neutropenia and Febrile Neutropenia by Onset Time.18
  • The median duration per event of any-grade neutropenia/febrile neutropenia was 0.26 months (range, 0-9.5) and grade ≥3 neutropenia/febrile neutropenia was 0.26 months (range, 0-3.4).19
  • Median absolute neutrophil count (ANC) within 2 and 4 weeks before onset of grade ≥3 infection was 2915/mm3 (range, 0-10,400/mm3) and 2900/mm3 (range, 0-10,400/mm3), respectively.18
  • Granulocyte-colony stimulating factor (G-CSF) therapy was administered (for prophylaxis and management) to 54.5% of patients (n=90).18
    • Filgrastim was used in 47.3% of patients, unspecified G-CSF in 10.3% of patients, pegfilgrastim in 9.1% of patients and lenograstim in 0.6% of patients.18

MajesTEC-1 Study (Cohort A): Occurrence of Neutropenia and Febrile Neutropenia by Onset Time18
Patients, n (%)
Time from first teclistamab dose
Total
≤2 months
>2-≤4 months
>4-≤6 months
>6-≤8 months
>8-≤10 months
>10-≤12 months
>12-≤14 months
>14-≤16 months
>16-≤18 months
>18-≤24 months
>24 months
Total patients, N
165
165
122
106
100
91
79
71
67
64
54
20
Neutropenia
Any grade
118 (71.5)
66
(40)
58
(47.5)
40
(37.7)
38
(38.0)
28
(30.8)
20
(25.3)
16
(22.5)
17
(25.4)
18
(28.1)
17
(31.5)
4
(20.0)
Grade 3/4
108 (65.5)
48
(29.1)
55
(45.1)
37
(34.9)
36
(36.0)
25
(27.5)
17
(21.8)
12
(16.9)
15
(22.4)
15
(23.4)
15
(27.8)
3
(1.8)
Febrile neutropenia
Any grade
8 (4.8)
2 (1.2)
1 (0.8)
2 (1.9)
0
0
2 (2.5)
0
0
0
0
1 (5.0)
Grade 3/4
6 (3.6)
1 (0.6)
1 (0.8)
2 (1.9)
0
0
2 (1.3)
0
0
0
0
1 (5.0)
Note: Includes patients either treated or experiencing neutropenia or febrile neutropenia within the specific time window. Percentages were calculated with the number of patients treated within each window as the denominator.

Management of Neutropenia

  • TECVAYLI was delayed during febrile neutropenia, grade 3 neutropenia with infection, and grade 4 neutropenia.18
  • G-CSF was recommended for grade ≥3 neutropenia with infection/fever and grade 4 neutropenia.18
  • Growth factors should be avoided during the step-up dosing schedule or during CRS, due to the potential for increased CRS severity from temporal myeloid cell stimulation.18

Garfall et al (2024)17 presented the incidence of hematologic TEAEs from Cohort A of the MajesTEC-1 study at a longer-term median follow-up of 30.4 months.


MajesTEC-1 Study (Cohort A): Hematologic TEAEs17
TEAEs, n (%)
N=165
Any Grade
Grade 3/4
Neutropenia
118 (71.5)
108 (65.5)
Anemia
91 (55.2)
62 (37.6)
Thrombocytopenia
69 (41.8)
38 (23.0)
Lymphopenia
60 (36.4)
57 (34.5)
Leukopenia
33 (20.0)
15 (9.1)
Abbreviation: TEAE, treatment-emergent adverse event.

Cohort C Safety Results

Touzeau et al (2024)20 published the incidence of hematologic AEs in Cohort C of the MajesTEC-1 study at a median follow-up of 28.0 months (range, 0.7-31.1).


MajesTEC-1 Study (Cohort C): Hematologic AEs ≥10%20
AE, n (%)
(N=40)
Any Grade
Grade 3/4
Neutropenia
28 (70.0)
26 (65.0)
Anemia
20 (50.0)
14 (35.0)
Lymphopenia
18 (45.0)
17 (42.5)
Thrombocytopenia
18 (45.0)
12 (30.0)
Abbreviation: AE, adverse event.
Note: Clinical data cutoff date of August 22, 2023.

Prophylactic Tocilizumab Cohort Safety Results

van de Donk et al (2024)21 presented the incidence of hematologic AEs in the prophylactic tocilizumab cohort of the MajesTEC-1 study at a median follow-up of 8.1 months (range, 0.9-13.2).


MajesTEC-1 Study (Prophylactic Tocilizumab Cohort): Hematologic TEAEs21
TEAEsa, n(%)
Prophylactic Tocilizumab Cohort
(N=24)

Any Grade
Grade 3/4
Neutropenia
15 (62.5)
15 (62.5)
Anemia
14 (58.3)
6 (25.0)
Thrombocytopenia
12 (50.0)
6 (25.0)
Lymphopenia
9 (37.5)
9 (37.5)
Leukopenia
6 (25.0)
5 (20.8)
Abbreviation: TEAE, treatment-emergent adverse event.
aTEAEs are listed if occurring at a grade 3/4 severity in ≥20% of patients.

Population Pharmacokinetics and Exposure-Relationships in MajesTEC-1

Miao et al (2023)22 developed a population PK model to evaluate the exposure of TECVAYLI in baseline demographic subgroups and other covariates. In addition, the exposure-safety relationships were explored using available data from 338 patients in the phase 1/2 MajesTEC-1 study.

Methods

  • Select safety analysis: The occurrence of grade ≥3 TEAEs, including anemia, neutropenia, lymphopenia, leukopenia and thrombocytopenia were estimated in patients who received TECVAYLI subcutaneous (SC) dosing in the phase 1/2 (Cohort A) portion of the trial (n=217). The analysis used predicted maximum concentration following the first treatment dose (Cmax,1stdose) and predicted maximum concentration following the first four QW treatment doses (Cmax,4doses) to characterize the exposure-safety relationship.

Results

Population PK Analysis
  • Among 338 patients (4840 PK observations) from the phase 1/2 MajesTEC-1 study, 83 patients (1976 PK observations) were administered TECVAYLI IV, and 255 patients (2864 PK observations) were administered TECVAYLI SC.
  • Among patients who received TECVAYLI SC, 28 patients (604 PK observations) received doses <RP2D, 203 (1679 PK observations) received RP2D, 21 patients (502 PK observations) received doses >RP2D, and 3 patients (79 PK observations) received flat dosing.
Exposure-Response Safety Analysis - Hematologic AEs
  • Among the 217 patients who received SC doses of TECVAYLI, the rates of grade ≥3 neutropenia, lymphopenia, leukopenia, and thrombocytopenia were not associated with concentrations of TECVAYLI when assessed in the predicted exposure quartiles. A decreasing trend was observed in the incidence of anemia, the highest rate was observed in the lowest quartile group.

clinical data - Majestec-2 Study

MajesTEC-2 (MMY1004; clinicaltrials.gov identifier: NCT04722146) is an ongoing, phase 1b, multicohort, open-label study evaluating the safety and efficacy of TECVAYLI in combination with other anticancer treatments in patients with MM.5-7,12,32

Study Design/Methods

Key Eligibility Criteria

  • Cohort A (TECVAYLI and DARZALEX FASPRO and pomalidomide): received 1 to 3 prior LOTs, including a PI and lenalidomide.12
  • Cohort C (TECVAYLI and nirogacestat): disease progression within 12 months of last LOT; ≥3 prior LOTs or double refractory to a PI, and an immunomodulatory drug and triple-class exposed to a PI, an immunomodulatory drug, and an anti-CD38 monoclonal antibody. Patients with prior exposure to BCMA-targeted therapy were permitted.5,25
  • Cohort D (Tec-Len): received ≥2 prior LOTs including a PI, an immunomodulatory drug and an anti-CD38 monoclonal antibody, no prior BCMA-targeted therapy.6
  • Cohort E (Tec-DR): received 1-3 prior LOTs including a PI, and an immunomodulatory drug, no prior BCMA-targeted therapy.7

Primary Endpoints

  • Cohort A: safety and dose-limiting toxicities.12
  • Cohort C: safety, tolerability, and optimal doses.5
  • Cohort D: safety.6
  • Cohort E: safety, dose-limiting toxicities, and laboratory abnormalities.7

Cohort A Safety Results

D’Souza et al (2024)12 presented the incidence of hematologic AEs in Cohort A of the MajesTEC-2 study at a median follow-up of 16.2 months (range, 0.5-34.5).


MajesTEC-2 Study (Cohort A: TECVAYLI, DARZALEX FASPRO, and Pomalidomide): Hematologic TEAEs12
TEAEa, n (%)
TECVAYLI + DARZALEX FASPRO + Pomalidomide
(N=17)

Any Grade
Grade 3/4
Neutropenia
15 (88.2)
15 (88.2)
Thrombocytopenia
7 (41.2)
1 (5.9)
Anemia
7 (41.2)
4 (23.5)
Lymphopenia
3 (17.6)
3 (17.6)
Leukopenia
4 (23.5)
2 (11.8)
Febrile neutropenia
1 (5.9)
1 (5.9)
Abbreviations: CTCAE, Common Terminology Criteria for Adverse Events; TEAE, treatment-emergent adverse event.
aAssessed per CTCAE version 5.0.

Cohort C Safety Results

Offner et al (2023)5 presented the incidence of hematologic AEs in Cohort C of the MajesTEC-2 study at a median follow-up of 14.7 months (range, 0.5-22.9).


MajesTEC-2 Study (Cohort C: TECVAYLI + Nirogacestat): Hematologic AEs (≥20% Overall)5
AEsa, n (%)
Total (N=28)
Any Grade
Grade 3/4
Neutropenia
23 (82.1)
21 (75.0)
Anemia
10 (35.7)
9 (32.1)
Thrombocytopenia
7 (25.0)
4 (14.3)
Abbreviations: AE, adverse event; CTCAE, Common Terminology Criteria for Adverse Events.aAEs were graded by CTCAE v5.0.
Note: Clinical data cutoff date of March 16, 2023.

Cohort D Safety Results

Tan et al (2023)6 presented the incidence of hematologic AEs in Cohort D of the MajesTEC-2 study at a median follow-up 10.8 months (range, 1.1-16.8).


MajesTEC-2 Study (Cohort D: Tec-Len): Hematologic AEs (≥25% Overall)6
AE, n (%)
All Patients (N=31)
Any Grade
Grade 3/4
Neutropenia
23 (74.2)
21 (67.7)
Anemia
12 (38.7)
6 (19.4)
Thrombocytopenia
11 (35.5)
5 (16.1)
Abbreviation: AE, adverse event; Tec-Len, TECVAYLI + lenalidomide.
Note: Clinical data cutoff date of March 16, 2023.

Cohort E Safety Results

Searle et al (2022)7 presented the incidence of hematologic AEs in Cohort E of the MajesTEC-2 study at a median follow-up of 8.4 months (range, 1.1-12.9).


MajesTEC-2 Study (Cohort E: Tec-DR): Hematologic AEs (Any Grade; ≥25% and/or Grade 3/4; ≥10%)7
AE, n (%)
(N=32)
Any Grade
Grade 3/4
Neutropenia
27 (84.4)
25 (78.1)
Thrombocytopenia
8 (25.0)
5 (15.6)
Anemia
7 (21.9)
4 (12.5)
Febrile neutropenia
4 (12.5)
4 (12.5)
Lymphopenia
4 (12.5)
4 (12.5)
Abbreviations: AE, adverse event; CTCAE, Common Terminology Criteria for Adverse Events, Tec-DR, TECVAYLI + DARZALEX FASPRO + lenalidomide.
AEs were assessed per CTCAE version 5.0.
Note: Clinical data cutoff date of October 17, 2022.

CLINICAL DATA - MajesTEC-4 study

MajesTEC-4 (EMN30; MMY3003; clinicaltrials.gov identifier: NCT05243797) is an open-label, randomized, multicenter, phase 3 study evaluating the safety and efficacy of Tec-Len and TECVAYLI alone vs lenalidomide alone as maintenance therapy in patients with NDMM.11,26

Study Design/Methods

SRI Cohorts

  • A SRI period consisting of 3 cohorts was used to establish safety prior to enrolling the randomized phase of the study.11
  • Maintenance regimen (2-year fixed duration): patients who achieved a complete response (CR) on Tec-Len after 1-year discontinued TECVAYLI and continued lenalidomide for an additional year.11
  • Key eligibility criteria: NDMM, receipt of 4 to 6 cycles of 3- or 4-drug induction therapy (PI and/or immunomodulatory drug ± anti-CD38 antibody), and ASCT (single or tandem ASCT permitted) ± consolidation with partial response (PR) or better.11
  • Primary endpoints: progression-free survival (PFS) and 12-month minimal residual disease (MRD)-negative CR.11
  • Key secondary endpoint: safety.11

Safety Results

Zamagni et al (2024)11 presented the incidence of hematologic AEs from the SRI Cohort 1 (Tec-Len; TECVAYLI QW to Q4W) at a median follow-up of 21.1 months (range, 14.8-23.8), SRI Cohort 2 (Tec-Len; TECVAYLI Q4W) at a median follow-up of 9.2 months (range, 1.2-12.2), and SRI Cohort 3 (TECVAYLI Q4W) at a median follow-up of 9.2 months (range, 3.7-11.5).


MajesTEC-4/EMN30 Study (SRI Cohorts): Hematologic AEs11
AEa, n (%)
Cohort 1
Tec-Len (QW to Q4W)
(N=32)

Cohort 2
Tec-Len (Q4W)
(N=32)

Cohort 3
Tec (Q4W)
(N=30)

Any Grade
Grade 3/4
Any Grade
Grade 3/4
Any Grade
Grade 3/4
Neutropenia
30 (93.8)
30 (93.8)
21 (65.6)
20 (62.5)
17 (56.7)
14 (46.7)
Leukopenia
9 (28.1)
3 (9.4)
1 (3.1)
0
1 (3.3)
1 (3.3)
Lymphopenia
2 (6.3)
1 (3.1)
4 (12.5)
4 (12.5)
4 (13.3)
4 (13.3)
Febrile neutropenia
3 (9.4)
3 (9.4)
3 (9.4)
3 (9.4)
0
0
Anemia
3 (9.4)
0
1 (3.1)
1 (3.1)
1 (3.3)
0
Thrombocytopenia
6 (18.8)
2 (6.2)
0
0
2 (6.7)
0
Eosinophilia
1 (3.1)
1 (3.1)
1 (3.1)
1 (3.1)
0
0
Abbreviations: AE, adverse event; EMN, Stichting European Myeloma Network; NCI-CTCAE, National Cancer Institute Common Terminology Criteria for Adverse Events; Q4W, once every 4 weeks; QW, weekly; SRI, safety run-in; Tec, TECVAYLI; Tec-Len, TECVAYLI + lenalidomide.
Note: Clinical data cutoff date of September 9, 2024.
aAEs (graded according to NCI-CTCAE version 5.0) occurring in >25% of patients with any-grade AEs or >1 patient with grade 3/4 AEs in any arm.

CLINICAL DATA - MajesTEC-5 study

MajesTEC-5 (GMMG-HD10; DSMM-XX; MMY2003) is an open-label, nonrandomized, phase 2 study assessing the safety and efficacy of TECVAYLI- and TALVEY-based combination regimens in patients with TE-NDMM.13,27

Study Design/Methods

  • Key eligibility criteria: presence of NDMM for which high-dose therapy (HDT) and ASCT were intended as part of the treatment plan, completion of HDT and ASCT within 12 months of induction start and within 6 months of the last ASCT (7 months if consolidation was received), receipt of only 1 prior LOT, and achievement of at least PR as per International Myeloma Working Group (IMWG) 2016 without evidence of progression at the time of enrollment.13
  • Primary endpoints: safety and tolerability.13

Safety Results

Raab et al (2024)13 presented the incidence of hematologic AEs from 3 induction cohorts of the MajesTEC-5 study.


MajesTEC-5 Study: Hematologic TEAEs13
TEAEa, n (%)
Arm A
Tec (QW)-DR
(n=10)

Arm A1
Tec (Q4W)-DR
(n=20)

Arm B
Tec (Q4W)-DVR
(n=19)

Total
(N=49)

Any Grade
Grade 3/4
Any Grade
Grade 3/4
Any Grade
Grade 3/4
Any Grade
Grade 3/4
Neutropenia
4
(40)

3
(30)

13
(65)

13
(65)

14
(73.7)

12
(63.2)

31
(63.3)

28
(57.1)

Lymphopenia
8
(80)

7
(70)

7
(35)

7
(35)

7
(36.8)

7
(36.8)

22
(44.9)

21
(42.9)

Thrombocytopenia
3
(30)

1
(10)

7
(35)

2
(10)

7
(36.8)

1
(5.3)

17
(34.7)

4
(8.2)

Anemia
5
(50)

0
6
(30)

4
(20)

5
(26.3)

0
16
(32.7)

4
(8.2)

Leukopenia
5
(50)

2
(20)

3
(15)

2
(10)

6
(31.6)

5
(26.3)

14
(28.6)

9
(18.4)

Abbreviations: DR, DARZALEX FASPRO and lenalidomide; DVR, DARZALEX FASPRO, bortezomib, and lenalidomide; NCI-CTCAE, National Cancer Institute Common Terminology Criteria for Adverse Events; Q4W, once every 4 weeks; QW, weekly; TEAE, treatment-emergent adverse event; Tec, TECVAYLI.
Note: Clinical data cutoff date of September 30, 2024.
aAdverse events were graded according to NCI-CTCAE version 5.0.

CLINICAL DATA - MajesTEC-7 study - TECVAYLI + TALVEY COHORT

MajesTEC-7 (MMY3005; clinicaltrials.gov identifier: NCT05552222) is a randomized, phase 3, open-label, multicenter study comparing the safety and efficacy of Tec-DR and Tal-DR vs DRd in patients with NDMM who are ineligible or not intended for transplant as initial therapy.10,28

Study Design/Methods

SRI Cohort 1 (Tec-DR)

  • A SRI period was used to establish safety prior to enrolling the randomized phase of the study.28
  • Key eligibility Criteria: NDMM either ineligible or not intended for ASCT.10,28
  • Primary endpoints: PFS, 12-month MRD-negative CR.10,28
  • Key secondary endpoint: safety.10,28

Safety Results

Touzeau et al (2024)28 presented the incidence of hematologic AEs from the SRI of 26 patients in Cohort 1 (Tec-DR) of the MajesTEC-7 study at a median follow-up of 13.8 months (range, 2.0-15.4).


MajesTEC-7 SRI Cohort 1 (Tec-DR): Hematologic TEAEs28
TEAE, n (%)
SRI Cohort 1
(N=26)

Any Grade
Grade 3/4
Hematologic TEAEsa
22 (84.6)
17 (65.4)
   Neutropenia
15 (57.7)
15 (57.7)
   Anemia
8 (30.8)
1 (3.8)
   Thrombocytopenia
4 (15.4)
4 (15.4)
   Febrile neutropenia
3 (11.5)
3 (11.5)
   Eosinophilia
3 (11.5)
0 (0)
Abbreviations: AE, adverse event; SRI, safety-run in; TEAE, treatment-emergent adverse event; Tec-DR, TECVAYLI + DARZALEX FASPRO + lenalidomide.
aAny-grade hematologic AEs in ≥10% of patients.

CLINICAL DATA - Redirectt-1 study - TALVEY + TECVAYLI Cohort

RedirecTT-1 (MMY1003; clinicaltrials.gov identifier: NCT04586426) is an ongoing, open-label, phase 1b/2 study evaluating the safety and efficacy of the combination of TALVEY and TECVAYLI in patients with RRMM.8,14,29,30

Study Design/Methods

  • Key inclusion criteria: relapsed or refractory or intolerant to established therapies including the last LOT, prior exposure to a PI, an immunomodulatory drug, and an anti-CD38 monoclonal antibody.14,30
  • Primary endpoints: dose limiting toxicity and ORR.14,30

Safety Results

Cohen et al (2025)14 published the incidence of hematologic AEs from the phase 1 dose-escalation segment of the RedirecTT-1 study.


RedirecTT-1 Study (TALVEY + TECVAYLI Cohort): Hematologic AEs14,30
AEa, n (%)
All Dose Levels
(N=94)

RP2R
(n=44)

Any Grade
Grade 3/4
Any Grade
Grade 3/4
Neutropenia
69 (73)
64 (68)
30 (68.2)
25 (56.8)
Anemia
53 (56)
36 (38)
18 (40.9)
11 (25.0)
Thrombocytopenia
40 (43)
28 (30)
12 (27.3)
9 (20.5)
Abbreviations: AE, adverse event; CTCAE, Common Terminology Criteria for Adverse Events; RP2R, recommended phase 2 regimen.Note: Clinical data cutoff date of March 15, 2024. Median follow-up time of 20.3 months (range, 0.5-37.1) and 18.2 months for all dose levels and RP2R cohorts, respectively.
aAEs were graded per CTCAE v5.0.

CLinical data - TRIMM-2 Study

TRIMM-2 (MMY1002; clinicaltrials.gov identifier: NCT04108195) is an ongoing, phase 1b, 2-part, multicohort, open-label study evaluating safety and efficacy of DARZALEX FASPRO regimens in combination with bispecific T-cell redirection antibodies in patients with RRMM.9,12,31

Study Design/Methods

  • Key eligibility criteria: ≥3 prior LOTs (including a PI and an immunomodulatory drug) or double refractory to a PI and an immunomodulatory drug, anti-CD38 monoclonal antibody >90 days prior allowed, prior bispecific antibodies (BsAbs) and CAR-T therapy allowed.31
  • Key primary endpoint: safety.31

Safety Results

D'Souza et al (2024)12 presented the incidence of hematologic AEs in TECVAYLI + DARZALEX FASPRO + pomalidomide cohort at a median follow-up of 38.3 months (range, 1.2-39.6).


TRIMM-2 Study (TECVAYLI + DARZALEX FASPRO + Pomalidomide Cohort): Hematologic TEAEs12
TEAE, n (%)
TECVAYLI + DARZALEX FASPRO + Pomalidomide Cohort
(N=10)

Any Grade
Grade 3/4
Neutropenia
6 (60.0)
6 (60.0)
Thrombocytopenia
3 (30.0)
2 (20.0)
Anemia
1 (10.0)
1 (10.0)
Lymphopenia
3 (30.0)
3 (30.0)
Leukopenia
2 (20.0)
1 (10.0)
Febrile neutropenia
2 (20.0)
2 (20.0)
Abbreviations: AE, adverse event; CTCAE, Common Terminology Criteria for Adverse Events; TEAE, treatment-emergent adverse event.
Note: Clinical data cutoff date of April 10, 2024. Median follow-up time of 38.3 months (range, 1.2-39.6).
aAEs were graded per CTCAE version 5.0

Rodriguez-Otero et al (2022)9 presented the incidence of hematologic AEs in the TECVAYLI and DARZALEX FASPRO cohort in the TRIMM-2 study at a median follow-up of 8.6 months (range, 0.3-19.6).


TRIMM-2 Study (TECVAYLI + DARZALEX FASPRO Cohort): Hematologic AEs (≥20%)9
AE, n (%)
Safety Profile (N=65)
Any Grade
Grade 3/4
Neutropenia
32 (49.2)
27 (41.5)
Anemia
27 (41.5)
18 (27.7)
Thrombocytopenia
21 (32.3)
16 (24.6)
Abbreviation: AE, adverse event.
Note: Clinical data cutoff date of April 6, 2022. Median follow-up time of 8.6 months (range, 0.3-19.6).

Literature Search

A literature search of MEDLINE®, Embase®, BIOSIS Previews®, and Derwent Drug File databases (and/or other resources, including internal/external databases) was conducted on 12 February 2025.

 

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