Administration of bispecific antibodies in patients with RRMM in outpatient and community settings: A roadmap

Bispecific antibodies (BsAbs) represent a novel class of immunotherapy, with agents such as teclistamab, talquetamab, and elranatamab approved for the treatment of relapsed/refractory multiple myeloma (RRMM). Currently, BsAbs are primarily administered in hospitals and academic settings to manage the adverse events associated with immunotherapies. To reduce disparities in RRMM treatment, including hospitalization rates and healthcare costs, and to improve patient experience, it is essential to develop strategies that support BsAb administration in outpatient settings. 

Garfall et al. published a roadmap for the safe and effective administration of BsAbs in outpatient and community settings in Frontiers in Oncology.

Three clinician advisory workshops were convened between June 2024 and September 2024 in the United States, Europe, and Latin America. Key elements discussed included clinical practice setup, starting immunotherapy treatment, and long-term management. 

Key learnings

Appropriate planning is essential for effective administration of BsAbs in outpatient settings. This includes MDT identification, clearly defined protocols and MDT roles, capacity planning, patient selection and SUD criteria, hospital readmission, patient and caregiver educational needs, and AE monitoring. 

Patients with low tumor burden, ECOG PS 0–2, stable mental status, and managed comorbidities may be suitable for outpatient BsAb treatment. A reliable caregiver, hospital access, and no active infections are essential to initiate outpatient treatment.

Ongoing patient management should focus on prevention and monitoring of AEs, including opportunistic infections. Nurses can support AE symptom triage, follow AE management protocol, escalate cases to physicians when needed, and advise patients when to seek hospital care.

Referrals from community practices should be made in collaboration with academic centers with experience in BsAb therapies. Following SUD, patients may return to a community center for ongoing treatment maintenance.