How to transition patients to community-based bispecific antibody therapy

The Multiple Myeloma Hub spoke with Shaji Kumar, Mayo Clinic, Rochester, US. We asked about transitioning patients to community-based bispecific antibody therapy.  

In this interview, Kumar discusses practical considerations for transitioning bispecific antibody therapy to community-based practice in patients with multiple myeloma. Kumar outlines strategies for monitoring and managing treatment-related toxicities, including cytokine release syndrome (CRS), neurological toxicities, cytopenias, and infections. Kumar also discusses patient education, supportive care, and the evolving role of less frequent and subcutaneous bispecific antibody administration in facilitating community-based treatment. 

Key points 

• Immunotherapeutic approaches, particularly bispecific antibodies and chimeric antigen receptor (CAR) T-cell therapies, are increasingly being used in multiple myeloma and can induce deep and durable responses.^1,2 
• Transitioning bispecific antibody therapy to community-based care could expand patient access while reducing reliance on specialist academic centers; however, these approaches must be safe and convenient for patients and practical for community oncologists.^1,2 
• Understanding and proactively managing bispecific antibody-associated toxicities is essential for expanding their use in the community setting.³ 
• CRS is a common adverse event associated with bispecific antibodies, and strategies to mitigate the risk include step-up dosing, prophylactic tocilizumab, and prophylactic corticosteroids.^3–6 
• Neurological toxicity, while less common with bispecific antibodies compared with CAR T-cell therapies, is another important potential adverse event that requires monitoring.^7,8 
• Bispecific antibodies can also be associated with cytopenias and infections, requiring close monitoring and appropriate prophylaxis.^3,9 
• Antiviral prophylaxis is recommended, with antibacterial and antifungal prophylaxis considered in patients with prolonged neutropenia and individual risk factors.^1,10 
• Intravenous immunoglobulin (IVIg) is an important component of infection prevention, particularly for patients receiving B-cell maturation antigen (BCMA)-targeted bispecific antibodies, given the high levels of hypogammaglobulinemia in these patients.^10,11 
• Patient counseling on potential toxicities and supportive care are important aspects of transitioning bispecific antibody therapies into community practice, particularly for unique toxicities, such as the oral and dermatological toxicities associated with talquetamab.¹² 
• Less frequent dosing and subcutaneous administration with newer bispecific antibody approaches could further improve convenience and facilitate community-based delivery.^2,13,14 
• While immune-based therapies are associated with a range of toxicities, with appropriate education, monitoring, and early intervention, most can be effectively managed in community practice, supporting broader access to these therapies.  

This educational resource is independently supported by Johnson & Johnson. All content is developed by SES in collaboration with an expert steering committee. Funders are allowed no influence.