Ep 4. Community Perspective: Partnerships and Outpatient Strategies for Bispecifics in Multiple Myeloma
Rohit Gosain, MD
Rahul Gosain, MD, MBA
S. Vincent Rajkumar, MD
Rafael Fonseca, MD
Beth Faiman, CNP, PhD
Key Points
- Bispecific antibody or chimeric antigen receptor (CAR) T-cell therapy are preferred treatments for relapsed or refractory multiple myeloma in the second line.
- Based on current prescribing information for bispecific antibodies, community oncologists should refer patients to hospital centers to manage inpatient step-up dosing.
- In the future, more refined dosing schedules and prophylaxis strategies may allow for complete outpatient administration of bispecific antibodies for multiple myeloma.
As part of a discussion on the rapidly changing early-line treatment landscape for relapsed or refractory multiple myeloma, Beth Faiman, CNP, PhD, of Cleveland Clinic; Rafael Fonseca, MD, of Mayo Clinic; and S. Vincent Rajkumar, MD, of Mayo Clinic, discussed how community oncologists can partner with academic centers to offer bispecific antibody therapy to patients with multiple myeloma after first relapse.
Over the past year, bispecific antibodies have rapidly expanded treatment options for relapsed or refractory multiple myeloma. Teclistamab plus daratumumab was approved in the second-line setting based on the MajesTEC-3 trial. The doctors agreed that bispecific antibodies or CAR T-cell therapy should be prioritized after the first relapse. For most bispecifics, the prescribing information suggests that patients be hospitalized for each dose in the step-up dosing schedule. Dr. Faiman’s center regularly works with community oncologists to admit patients for step-up dosing before transitioning them back to community centers with written protocols regarding prophylaxis.
Moving forward, however, the process of referring and admitting patients to large centers for treatment initiation may hinder the adoption of bispecific antibodies in community settings. Community oncologists should become familiar with the available second-line options so that they can discuss treatment directly with patients, said Dr. Rajkumar. On the academic side, researchers need to refine prophylaxis and step-up dosing guidelines so that community providers are eventually able to safely offer bispecific antibodies in outpatient settings, much like daratumumab, he added.