Clinical Summary: 

• Design/Population: The multicenter, phase 2 OPTEC study evaluated outpatient administration of teclistamab and talquetamab with prophylactic tocilizumab in patients with relapsed or refractory multiple myeloma treated in community-based settings. 
• Key Outcomes: Prophylactic tocilizumab reduced cytokine release syndrome rates to 5% with teclistamab and 14% with talquetamab, with all events limited to grade 1 except a single grade 2 hospitalization. No grade ≥3 CRS events or ICANS were observed. The overall response rate with teclistamab was 82%, and 74.4% of patients remained progression-free after a median follow-up of 11.8 months.
• Clinical Relevance: These findings support a practical outpatient model for administering bispecific antibodies in community oncology settings and may significantly expand patient access to these highly effective therapies.

Peter Forsberg, MD, Colorado Blood Cancer Institute and Sarah Cannon Research Institute, Denver, Colorado, discusses results from the phase 2 OPTEC study evaluating strategies to safely administer bispecific antibodies outside of academic medical centers. The trial incorporated prophylactic tocilizumab, structured outpatient monitoring, caregiver support, and home-based symptom assessment to facilitate community-based treatment with teclistamab and talquetamab.

The study demonstrated a substantial reduction in cytokine release syndrome compared with historical experience from MajesTEC-1 and MonumenTAL-1, while maintaining strong clinical activity and a safety profile consistent with prior studies. These findings suggest that outpatient bispecific therapy can be delivered safely in appropriately selected patients and provide a framework for broader implementation of these transformative therapies across community oncology practices.

Dr Frosberg presented these results at the American Society of Clinical Oncology (ASCO) Annual Meeting in Chicago, Illinois. 

Transcript: 

Hi, I'm Peter Forsberg. I'm a myeloma specialist at the Colorado Blood Cancer Institute in Denver, Colorado, and one of the myeloma research leads for the Sarah Cannon Research Network. I'll be presenting data here at ASCO from our multi-arm OPTEC trial, Optec/Optal. 

This is a phase 2, multicenter study evaluating different strategies to increase adoption and utilization of bispecific T-cell engagers in outpatient, community-based clinical settings. The data we're discussing focus on 2 arms: one with teclistamab and one with talquetamab. Both arms utilized prophylactic tocilizumab, administered at 8 mg/kg prior to the first step-up dose, with the goal of enabling outpatient community-based administration of these bispecific antibodies.

As background, cytokine release syndrome (CRS) is one of the most common toxicities associated with these agents. In the MajesTEC-1 study, CRS occurred in approximately 72% of patients treated with teclistamab, and in MonumenTAL-1, CRS rates ranged from 73% to 79% with talquetamab. Prior studies had suggested that prophylactic tocilizumab could substantially reduce CRS rates without compromising efficacy.

As of January 2026, 43 patients had enrolled in the teclistamab arm and 7 patients in the talquetamab arm.What we found was a dramatic reduction in CRS. In the teclistamab arm, the CRS rate was only 5%, and all events were grade 1. In the talquetamab arm, CRS occurred in 14% of patients, again all grade 1. There were no grade 3 or higher CRS events, no recurrent CRS events of concern, and no neurotoxicity or ICANS observed. Only one patient required hospitalization for a grade 2 CRS event.

In addition to prophylactic tocilizumab, patients followed a structured outpatient monitoring approach. They were required to remain within 60 minutes of the treatment center, have a caregiver available during the first 48 hours after step-up dosing and the first full dose, and perform simple home monitoring such as temperature checks and pulse oximetry. Patients were also recommended to receive IVIG if IgG levels fell below 400 mg/dL. 

In terms of safety, the adverse event profile was generally what we would expect with these agents. The most common grade 3 or higher adverse events included neutropenia, with grade 3 neutropenia in four patients and grade 4 neutropenia in six patients. There were also isolated cases of grade 3 anemia and febrile neutropenia. Infections occurred in 47% of patients treated with teclistamab, with 19% experiencing grade 3 or higher infections. In the talquetamab arm, infections occurred in 57% of patients, with 29% being grade 3 or higher. Importantly, we did not observe any new or unexpected safety signals.

From an efficacy standpoint, responses remained very encouraging. In the teclistamab arm, best overall responses included 3 stringent complete responses, 6 complete responses, 11 VGPRs, and 8 partial responses. Among the 34 evaluable patients, the overall response rate was 82%. In the talquetamab arm, one patient achieved a stringent complete response, while the remaining patients were not yet evaluable at the time of analysis.

With a median follow-up of 11.8 months, 74.4% of patients treated with teclistamab had not experienced disease progression. Taken together, these data suggest that a single dose of prophylactic tocilizumab administered before the first step-up dose can substantially reduce the incidence of CRS without negatively affecting safety or efficacy. Most importantly, these findings support a practical pathway for outpatient, community-based administration of teclistamab and talquetamab.

Because these are highly effective and transformative therapies, developing safe outpatient treatment models is critical if we want to expand access beyond academic centers. Based on these results, the protocol has now been amended to add an additional arm evaluating prophylactic oral dexamethasone with teclistamab, and enrollment remains ongoing.

Source: 

Frosberg P, Andorsky D, Rifkin RM, et al. Optec/Optal: A phase 2 study to evaluate outpatient (OP), step-up administration of teclistamab (Tec) or talquetamab (Tal) with prophylactic tocilizumab (prophyToci) in patients (pts) with relapsed/refractory multiple myeloma (RRMM). Presented at the ASCO Annual Meeting. May 29 - June 2, 2026. Chicago, Illinois. Abstract 7510.