ASH 2024: Rapid Uptake of Bispecific Antibodies for R/R Multiple Myeloma Observed in Community Oncology Settings

Ira Zackon, MD, medical director at Ontada and practicing hematologist at New York Oncology Hematology, discussed in an interview with Pharmacy Times® his analysis of real-world bispecific antibody (BsAb) use in patients with relapsed/refractory multiple myeloma (R/R MM) across the United States. The data, set to be precedented at the 66th American Society of Hematology (ASH) Annual Meeting and Exposition in San Diego, California, indicates a rapid increase in the utilization of BsAbs in community oncology settings, posing new considerations for pharmacists and their patients as BsAbs become a standard of care treatment option.

In part 1 of this sit-down Q&A on-site at ASH, Zackon discusses the implications of these results in real-world clinical settings, while providing more details about specific population data analyzed in the trial.

Pharmacy Times: What are the real-world implications of the rapid uptake of BsAbs in the treatment of relapsed/refractory multiple myeloma? How does this impact patient access to these novel therapies and potential treatment outcomes?

Ira Zackon: First of all, we're talking about myeloma, a chronic disease, and we've seen a lot of advances over 20 years now. The bispecific antibodies (BsAbs) are a somewhat more recent entrance to the way we may treat patients with myeloma, and they're an immune therapy. What our research was really looking at, they were first approved, the first one that was approved was in October 2022. What we did was look back using an electronic health record database, which is used across the US Oncology Network, as well as some other community-based practices. So, a fairly large size of data. The primary question is: how much is it being used early on? This is a very early, high-view look. It was very encouraging that we saw, when you looked at even the first full year of 2023, about 46% of the patients who would have been considered eligible received a BsAb. In 2024, a partial year, because we looked up to July of this year, it was up to about 54%. That's just the data. I think that's what drew some interest, because there's been concern about, how will this be adaptable and adopted in the community setting.

It's really important that this occur, because most patients still receive their care in a community setting closer to where they live, and in order to have full access to patients who would be eligible, it's really important that community oncology is able to deliver these therapies. There are challenges to it, which is, was part of the concern in terms of questioning, you know, will this be difficult to deliver? Part of that is that you require to do what's called step-up dosing initially. It's just a way of easing into the therapy on the doses to try and minimize some of the immune reactions that can occur. You need a hospital partner to do these brief admissions for the initial dosing before you can bring it back into the routine office setting. That could be potentially challenging for some practices, depending on their hospital partnerships, bed access. You have to just really develop some expertise in some of these immune therapy side effects, or the things that can happen, so that you're delivering it safely and being able to monitor your patients. Yu do have to in so you do have to invest in your staff, clinical staff, as well as some of the logistics of delivering the therapy.

Pharmacy Times: Could you elaborate on the patient characteristics and treatment patterns observed in this study? Are there any specific patient populations that may be more likely to receive BsAb therapy?

Zackon: We did look at that again, at a very high level, because we're using available, what we call structured data, in the electronic health record, so it’s easy to at least analyze at this level. We did see that the median age of the patients who received—we identified just over 200 patients that received BsAbs, and 62 other patients that did not receive a BsAb and yet had at least 5 lines of therapy. Those are the qualifiers, because it's been approved for after 4 lines of therapy. We saw they tended to be a little bit younger. The median age at the time they received therapy was 69 versus about 73 in those that did not. We did not see any difference in sex, male versus female. We did not see any difference in race, so white versus Black versus other ethnicities. That is important, because we know that myeloma occurs with increased incidence in Black Americans. The proportion of patients that were Black were about 16% and 17% in these groups, which is proportional to Black Americans in the United States population. That was at least an encouraging signal that we were not seeing any disparity, at least in terms of these early adoption of therapies. We also saw that the patients tended to be perhaps a little healthier, we call better performance status, in the 2 groups. It just may reflect that those patients who were able to get bispecifics in this setting, or how physicians were selecting the patients that may have been a little bit younger for myeloma, which is still a disease primarily of our older age population, and perhaps a little bit healthier overall, in terms of their day-to-day function. That likely will, I think, change. We have to follow this up more to understand those.