Talquetamab belongs to an emerging class of T-cell-redirecting bispecific antibodies. It works by binding GPRC5D, a target abundantly expressed on malignant plasma cells, on one arm, and CD3 on T cells on the other, physically bridging the immune cell to the tumor and triggering a lethal synapse. The drug has shown impressive antimyeloma activity in patients whose disease had exhausted other options, and it was approved on the strength of those responses. But GPRC5D is also expressed in certain normal tissues, and the collateral consequences have become a defining feature of the treatment profile: dry mouth, nail changes, peeling skin, weight loss, and, most distinctively, dysgeusia, the distortion or loss of taste.

The Würzburg team, led by Anna Fleischer and colleagues, set out to move beyond the blunt binary of an adverse-event checklist. They combined objective taste-strip testing, in which filter-paper strips soaked with sweet, sour, salty, bitter, and umami solutions at four concentrations each are placed on the tongue, with a study-specific questionnaire, the EORTC QLQ-C30 quality-of-life instrument, and the PHQ-4 screening tool for anxiety and depression. Participants were asked to recall when their taste problems began, how their appetite and weight had changed, whether their food preferences had shifted, and whether they had ever considered abandoning the drug. The assessments took place during routine visits between 2024 and 2025, and patients were instructed to abstain from food, drink, smoking, and chewing gum for at least an hour beforehand.

The objective results were sobering. The median number of correctly identified taste stimuli was just 2.5 out of the administered panel, with an interquartile range of 0.75 to 7.25 and an observed range spanning zero to 14. Eight patients, 25 percent of the cohort, could not correctly identify a single taste. On the patient-reported side, the picture was equally stark: 15 of the 27 participants whose impairment could be graded described it as severe or very severe. Dry mouth, a frequent companion of taste loss, affected more than four in five patients. The symptom also arrived fast, with nearly 72 percent of participants recalling onset within 14 days of their first dose, a timing pattern that suggests the gustatory system is hit early in the course of treatment.

The most consequential finding, however, was the link between measured taste performance and appetite. Twenty patients, 62.5 percent of the cohort, reported currently reduced appetite, and their mean taste-identification count was 2.45, compared with 7.83 among those without current appetite reduction. That difference of 5.38 correct identifications, with a 95 percent confidence interval of minus 8.20 to minus 2.57 and a p-value of 0.0006, held up under rank-based sensitivity analysis and when a single participant with resolved appetite loss was excluded. In plain terms, patients whose tongues performed worse on the test were the same patients who had lost the desire to eat, a convergence of objective measurement and lived experience that strengthens the case that the sensory deficit carries real nutritional consequences.

The downstream effects on the body were visible in the numbers. Half of the participants reported directional weight loss since starting talquetamab, with a median loss of 4.5 kilograms and individual losses reaching 15 kilograms. Those reporting weight loss also scored substantially higher on the EORTC appetite-loss scale, 66.7 versus 33.3 points, although the binary appetite question and weight history did not align neatly, a discrepancy the authors attribute to the different time windows each measure captures. Food preferences had shifted in more than half of patients: savory and salty foods were favored by about 40 percent, while sweet foods and fruit appealed to a similar share, and a notable minority developed outright aversions to sweetness or alcohol. The heterogeneity, the authors note, argues against any one-size-fits-all dietary prescription.

Perhaps the most clinically alarming statistic concerns treatment persistence. Ten patients, nearly a third of the cohort, had seriously considered stopping talquetamab, and seven of them explicitly cited taste disturbance as a reason. That means roughly one in five patients in the study linked this sensory side effect to thoughts of abandoning an otherwise effective therapy. The authors are careful to distinguish these contemplations from actual nonadherence, since no missed doses or discontinuations were documented, but the signal is hard to ignore. In an era when bispecific antibodies are extending survival in myeloma, a side effect potent enough to make patients weigh quitting is a problem that supportive care can no longer treat as an afterthought.

Quality-of-life data reinforced the connection between taste and well-being. Mean global health status on the EORTC scale was 50.5 out of 100, and it correlated positively with taste-identification counts, with a Pearson correlation coefficient of 0.406 and a p-value of 0.021. Among patients whose current impairment could be graded, greater impairment tracked with both lower taste scores and lower global health. Role functioning and social functioning posted the lowest mean scores among the functional scales, while fatigue and appetite loss dominated the symptom scales. Psychological distress, measured by the PHQ-4, was heterogeneous rather than uniformly severe: just over half of participants showed minimal distress, about a third mild, and none severe, a reminder that taste loss can erode the pleasure of eating without necessarily registering as depression.

The authors are refreshingly candid about the limits of what a single-center, cross-sectional survey of 32 patients can establish. There was no pretreatment taste assessment, no contemporaneous comparator group, and no way to verify a norm-referenced hypogeusia classification from the aggregate counts retained in the records. Recalled onset dates and weight changes are vulnerable to memory distortions, the study-specific questionnaire was not a validated dysgeusia instrument, and the many exploratory associations were examined without correction for multiple comparisons. Crucially, a cross-sectional correlation cannot prove that talquetamab causes the taste loss, that taste loss causes the appetite reduction, or that the two share some third cause such as disease burden, oral infection, or other medications. The universal symptom reporting in this selected sample should also not be read as the true incidence of dysgeusia among all patients receiving the drug.

Even with those caveats, the study lands at a moment of genuine clinical need. Earlier work by the same group and others had described taste and oral symptoms under talquetamab, but this analysis is among the first to tie measured gustatory performance to appetite and quality of life within a single cohort, and to quantify how often the burden reaches the point of treatment doubt. The early onset narratives argue for proactive conversations about taste soon after the first dose, and the authors suggest that individualized exploration of tolerated flavors, textures, and hydration, alongside nutritional assessment when taste complaints, reduced intake, or weight change appear, is a reasonable supportive-care stance. What remains to be proven, they emphasize, is whether any of these strategies actually work: neither dietary adjustments nor dose modification has been tested prospectively. Future studies, they write, should track taste and patient-reported outcomes serially before, during, and after treatment, distinguish temporary improvement from sustained recovery, and preserve item-level taste responses so that the full sensory profile of this remarkable but demanding therapy can finally be mapped.

Subject of Research: Taste dysfunction, appetite loss, and quality of life in multiple myeloma patients treated with the bispecific antibody talquetamab

Article Title: Gustatory dysfunction under talquetamab therapy in multiple myeloma: a cross-sectional study of patient-reported course, nutritional changes, and quality of life

Article References: Fleischer, A., Burger, C., Roll, M., Panther, F., Strunz, P.-P., Peter, J., Kadel, S.-K., Gesierich, A., Mersi, J., Waldschmidt, J., Kortüm, M., Einsele, H., Maatouk, I., & Rasche, L. (2026). Gustatory dysfunction under talquetamab therapy in multiple myeloma: a cross-sectional study of patient-reported course, nutritional changes, and quality of life. Supportive Care in Cancer, 34(10), Article 1059. https://doi.org/10.1007/s00520-026-11288-4

Image Credits: AI Generated

DOI: 10.1007/s00520-026-11288-4

Keywords: talquetamab, multiple myeloma, dysgeusia, bispecific antibody, GPRC5D, taste strips, appetite loss, weight loss, quality of life, supportive care, EORTC QLQ-C30, immunotherapy side effects

The research team, led by Ayami Koike and colleagues in the Department of Gynecology and Obstetrics, enrolled 153 patients newly diagnosed with gynecologic malignancies between July 2022 and March 2026. After accounting for withdrawals and incomplete data, 105 patients formed the analytical cohort. Each participant completed a brief validated self-administered diet history questionnaire capturing dietary habits over the preceding month, once at baseline before treatment began and again one day before the third chemotherapy cycle. Appetite and quality of life were measured with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30, known as the EORTC QLQ-C30, while treatment-related symptoms were tracked using the patient-reported version of the Common Terminology Criteria for Adverse Events, or PRO-CTCAE.

The headline result was stark. Forty-one of the 105 patients, or 39.0 percent, reported appetite loss before their third chemotherapy cycle. Compared with patients who maintained their appetite, this group experienced a median additional reduction in daily energy intake of 320.8 kilocalories, with a 95 percent confidence interval stretching from 454.5 down to 119.3 kilocalories per day. The decline was not confined to total calories. Protein intake fell by a median of 12.0 grams per day, fat by 8.3 grams, and carbohydrate by 25.6 grams more in the appetite loss group, each difference statistically significant. Crucially, the proportion of energy derived from protein, fat, and carbohydrate, the so-called PFC ratio, did not differ between the groups, indicating that appetite loss shrinks the entire diet roughly proportionally rather than skewing it toward any particular macronutrient.

The micronutrient analysis added a layer of nuance. Of the 16 clinically relevant micronutrients examined, 13 showed significantly larger decreases in the appetite loss group after correction for multiple comparisons using the Benjamini-Hochberg false discovery rate procedure. Iron, zinc, magnesium, and vitamin B2 displayed the largest effect sizes, with Hedges’ g values ranging from minus 0.68 to minus 0.76, while the remaining nine nutrients showed small to moderate effects. Yet when the researchers adjusted for total energy intake by expressing micronutrient consumption as nutrient density per 1,000 kilocalories, none of the between-group differences remained significant. In other words, the diet of patients with appetite loss appears to shrink uniformly, preserving its nutritional composition in relative terms even as absolute intakes of vitamins and minerals fall in ways that could matter for patients facing prolonged energy restriction.

At the level of individual food groups, a telling pattern emerged. Patients with appetite loss showed a significantly greater decline in red and processed meat consumption, with a median difference of minus 6.1 grams per day, while dairy products and legumes also trended downward. Poultry, fish, vegetables, fruits, sweets, and staple carbohydrate sources such as rice and other grains showed no meaningful differences between groups. This selective retreat from meat is consistent with a growing body of literature identifying meat as the most commonly aversive food during anticancer treatment, and with studies linking impaired taste function to reduced preference for protein-rich foods. The researchers suggest that altered food preferences during chemotherapy, rather than a uniform distaste for all foods, may be shaping what patients can and cannot bring themselves to eat.

When the team probed which treatment side effects were most closely tied to appetite loss, one stood out above the rest. In multivariable linear regression models adjusted for age and body mass index, taste changes were significantly associated with appetite loss scores, carrying a beta coefficient of 8.7 with a 95 percent confidence interval of 1.3 to 16.1 and a p value of 0.02. Fatigue, constipation, nausea, mouth sores, diarrhea, and dry mouth all failed to reach significance. The finding carries a provocative implication: the distortion of taste that many patients describe during chemotherapy may be a principal driver of the anorexia that follows, rather than nausea or gastrointestinal distress as is often assumed.

The connection to quality of life was equally compelling. Changes in appetite loss scores were negatively correlated with changes in global health status and quality of life, with a Spearman correlation coefficient of minus 0.31 and a p value of 0.002. The associations were strongest for role functioning, cognitive functioning, social functioning, and emotional functioning, with correlation coefficients of minus 0.49, minus 0.42, minus 0.35, and minus 0.28 respectively, and weakest for physical functioning, which did not reach statistical significance. This gradient suggests that appetite loss may weigh more heavily on psychological and social well-being than on the body’s mechanical capacity, a pattern consistent with prior research linking poor food intake to depressive symptoms and diminished quality of life in cancer populations.

To test whether appetite loss tracks with quality of life fluctuations over time, the investigators turned to a separate multicenter cohort of 127 patients with gynecologic malignancies treated at five Japanese institutions between June 2020 and March 2024. Patient-reported outcomes were collected longitudinally over a 15-week observation period, revealing that global quality of life scores fluctuate within each chemotherapy cycle, dipping in the first week after treatment and recovering by the second. Machine learning models built to identify which symptom changes best predicted clinically meaningful quality of life shifts, defined as a change of at least 10 points on the EORTC QLQ-C30 global score, consistently ranked appetite loss among the most influential features, with model interpretation performed using Shapley additive explanations. The implication is sobering: some of the most clinically relevant swings in a patient’s well-being may occur between hospital visits, precisely when clinicians are least able to observe them.

Notably, appetite loss did not translate into the objective nutritional markers clinicians often rely upon. The proportion of patients losing more than 5 percent of body weight was similar between groups, at 26.8 percent versus 21.9 percent, and serum albumin levels and the Prognostic Nutritional Index, a composite of albumin and lymphocyte count, showed no significant differences. This dissociation between subjective dietary collapse and stable laboratory parameters suggests that conventional biochemical surveillance may miss the early, patient-centered harm caused by appetite loss, and that patient-reported measures deserve a more central role in monitoring. Nutritional counseling, it is worth noting, was provided to only 7.6 percent of patients, with no significant difference between groups.

The authors are careful about causality. Appetite was assessed over the preceding week while diet questionnaires covered the preceding month, so the temporal direction of the association cannot be established, and the definition of appetite loss included mild symptoms that may not generalize to severe anorexia. Selection bias cannot be excluded, serum zinc was not measured, and residual confounding by postoperative recovery remains possible, since most patients received adjuvant chemotherapy after surgery. Sensitivity analyses, however, strengthened the core findings: restricting the analysis to patients without baseline appetite loss, adjusting for surgical approach and the interval from surgery to chemotherapy, and grading appetite loss severity all produced directionally consistent results. The clinical message is clear. Because appetite loss and taste alterations are common, detectable, and plausibly treatable, whether through dietary counseling tailored to taste changes, oral nutritional supplements, or emerging pharmacological options such as olanzapine and mirtazapine that have improved both appetite and quality of life in cancer trials, systematic screening with electronic patient-reported outcome tools could catch the problem before it erodes a patient’s nutrition and spirit mid-treatment.

Subject of Research: Appetite loss, dietary intake, and quality of life during chemotherapy for gynecologic cancer

Article Title: Appetite loss during chemotherapy is associated with reduced dietary intake and quality of life in patients with gynecologic cancer: a prospective observational study

Article References: Koike, A., Mizuno, R., Higashiyama, N., Inayama, Y., Umemiya, M., Ikeda, K., Kubo, N., Tokushige, Y., Nagasawa, T., Matsumura, N., Miyamoto, T., Taki, M., Yamanoi, K., Murakami, R., Yamaguchi, K., & Mandai, M. (2026). Appetite loss during chemotherapy is associated with reduced dietary intake and quality of life in patients with gynecologic cancer: a prospective observational study. Supportive Care in Cancer, 34(10), Article 1046. https://doi.org/10.1007/s00520-026-11276-8

Image Credits: AI Generated

DOI: 10.1007/s00520-026-11276-8

Keywords: gynecologic cancer, chemotherapy, appetite loss, dietary intake, quality of life, taste changes, micronutrients, EORTC QLQ-C30, PRO-CTCAE, supportive care, nutrition, patient-reported outcomes