ASH 2024: Expert Discusses Challenges, Future Research Opportunities With Bispecific Antibodies in Multiple Myeloma

In part 2 of an interview with Pharmacy Times®, Ira Zackon, MD, medical director at Ontada and practicing hematologist at New York Oncology Hematology, discusses some of the challenges and opportunities presented by the widespread uptake of bispecific antibodies (BsAbs) for the treatment of relapsed/refractory multiple myeloma and elaborates on the findings of his abstract presented at the 66th American Society of Hematology (ASH) Annual Meeting and Exposition. The research found a rapid increase in the utilization of BsAbs across the country in community oncology settings.

Pharmacy Times: What are the primary challenges and opportunities associated with the administration of BsAbs in a community oncology setting? How can these challenges be addressed to optimize patient care?

Ira Zackon: I touched on that a little bit in terms of this initial phase of the step-up dosing and needing a hospital partner. For example, in my practice in upstate New York, we did not have access to hospital beds that we would normally use initially, and we had to partner with other academic institutions in our region to get the patients started on therapy and then continue the therapy. Now we're able to do it ourselves. That's one phase of initial challenge; you must refer your patient elsewhere. Can they get there? Do they have the transportation? Do they have some support to do that? As far as clinically delivering the therapy, there are some early immune-activating syndromes that can happen, and you can get sick with these. Fortunately, they occur with relatively low incidence and low severity with these BsAbs. But your clinical team needs to be able to early recognize these symptoms to just stratify, how severe? How do we intervene? You must develop this expertise in it, very doable at the community level, but it's adapting to a new therapy and the logistics of that. A practice must probably have enough resourcing to be able to, just the logistics and this clinical education of delivering the therapies.

Pharmacy Times: How will long term follow up help flesh out this area of research?

Zackon: This is, as I mentioned, a very high-level early look, because we're only talking about approvals pretty much since 2023 so we're not even 2 full years, or just about 2 full years since the first approval. We need to follow this up, refresh some of this data, really, year over year, to see the patterns of utilization. Are we seeing an increase in the utilization for appropriate patients—that would be an encouraging sign. And having more patients be able to see more of the patient characteristics, and we could look more at some of the disease characteristics, just the biological aspects of myeloma. I think importantly, with more years of follow up, then we could begin to look at outcomes. How are patients doing in terms of their remission rates in terms of their overall survival and begin to look at bispecifics in the real-world compared to the clinical trial data by which it's approved. That's important in terms of providing a real-world perspective, because the differences are, these are patients. This is the whole range of patients with myeloma being seen and being treated and cared for. We know that in clinical trials, one, it's a much smaller percentage of patients who can go on to a clinical trial for whatever reason. Sometimes it's just they either qualify or they don't qualify, or they simply choose not to, or they're not able to because of some of the logistics of the trial. It underrepresents the real-world population. It's important to eventually look at this data as to, well, what's happening in our larger group of patients who are much more heterogeneous and are much more mixed in terms of their age, their other health, their factors that can influence social determinants of health. We'll be able to look at this in our database with more time of follow up, where we can do a much deeper dive on this, which will be important.