Donna Catamero, ANP-BC, OCN, CCRC, outlines best management strategies for treating patients receiving teclistamab who experience cytokine release syndrome.
Patients with multiple myeloma who receive teclistamab (Tecvayli) are at an increased risk of developing cytokine release syndrome (CRS). According to Donna Catamero, ANP-BC, OCN, CCRC, nurses can provide the best possible care to these patients by learning to recognize CRS early and anticipating when treatment and escalation are needed.
“We found that by intervening early on, we didn’t [see] recurrence of CRS,” she said. “Being aggressive at the first signs led to no recurrence.”
Catamero, who is the associate director of myeloma research at Mount Sinai, and a member of the International Myeloma Foundation Nurse Leadership Board, recently presented on safety data from the 1/2 MajesTEC-1 study (NCT03145181/NCT04557098) during the 48th Annual Oncology Nursing Society Congress. In an interview ahead of her presentation, Catamero spoke with Oncology Nursing News® to discuss the key takeaways from the study and the overall implications for oncology nursing practice.
Among patients treated on the study, 72.1% of patients experienced CRS (n = 119). Most events were grade 1 or 2, with 1 grade 3 infection-related event. The median time to onset of CRS was 2 days (range, 1-6) and the median duration until resolution was 2 days (range, 1-9). Almost all CRS events occurred before cycle 1, during the step-up dose (SUD).
The presentation demonstrated that combined use of premedication and a SUD regimen were effective in managing CRS in this patient population. Nurses must frequently monitor patients during the SUD frame, and to employ supportive care measures as needed—which may include tocilizumab (Actemra), intravenous fluids, low-flow oxygen, steroids, and single vasopressor.
It is also important for nurses to rule out infection as a differential diagnosis. This is key in ensuring that CRS is properly diagnosed and treated. Signs that indicate a physician should be consulted include a temperature higher than 38 °C, a drop in blood pressure or O2 saturation, complaints of pain or chills, or other signs of neurotoxicity.
According to Catamero, when nurses partner with patients and physicians to recognize and report CRS symptoms early on, it allows for rapid intervention, and seamless transfer to intensive care, if necessary.
Editor’s Note: This study was funded by Janssen Research & Development. The principal study author has received payment from GSK, BMS, and Janssen.
Catamero D, Blázquez Benito P, Shenoy S, Chastain K, and Kruyswijk S. Managing cytokine release syndrome in relapsed/refractory multiple myeloma: experience with teclistamab in the MajesTEC-1 study. Poster presented at: 48th Annual Oncology Nursing Society Congress; April 26-30, 2023; San Antonio, Texas. Accessed April 27, 2023. https://ons.confex.com/ons/2023/meetingapp.cgi/Paper/13452