Bispecifics in MM: Future Directions in Care
Closing out their panel on bispecifics in relapsed/refractory multiple myeloma, key opinion leaders share closing thoughts and hopes for the future treatment landscape.
Transcript:
Rafael Fonseca, MD: We’re going to do a little roundtable of final comments and take-home messages. Before we do that, Dr Cook, I’ve been remiss in not asking about the role of the rest of the team. To be effective with the use of bispecifics, it’s a team effort. It takes a village. I wonder if you could make some comments in that regard?
Joselle Cook, MBBS: Definitely. We need our nurses to help follow these patients with respect to the remote patient monitoring. That’s the whole crux of our practice and how we’re able to do this on an outpatient basis. Our pharmacists are critical [for] medication reconciliation, making sure the patients understand what medications they’re taking and when to take it, and making sure they’re not [receiving] Tylenol or taking Advil on the side. Those are all things that we forget about, but we need that village approach to help reinforce [them] with our patients, not to mention there [are] cost implications with this treatment. [Regarding] financial advisors, setting patients up with them is really critical because different patients will have different co-pays and that’s a serious, serious toxicity that we don’t talk about often enough. Arrangement with a social worker and financial advisor is also key to our team here at Mayo Clinic.
Rafael Fonseca, MD: Thank you very much. I know one of the thoughts is how do we integrate all of this? I can see how, as Dr Gertz was mentioning, there’s going to be networks; we might have teams of nurses and maybe other providers that help us deliver this in the community setting. It’s interesting to see how things will evolve. Let’s go to our final round of comments. I’m going to start with Dr Kumar, Dr Gertz, and then Dr Cook. Dr Kumar, a pearl of wisdom for our audience to take home?
Shaji Kumar, MD: I think the important thing with the bispecifics, and generally with immunotherapy, is making sure that the patients have access to those therapies consistent with the current indications. Don’t wait too long for the disease to be refractory to everything before we actually refer [patients] for these immunotherapies. I think with increasing knowledge about the toxicity and its management, as Dr Gertz said, I anticipate that the bispecific antibodies are going to be widely available in the community practice with selective patients perhaps getting transferred to larger institutions for CAR [chimeric antigen receptor] T[-cell] therapies.
Rafael Fonseca, MD: Thank you very much. Dr Gertz?
Morie Gertz, MD: I think the issue we’re going to be facing in the future is an embarrassment of riches. There are 7 bispecifics that, as I review the data, I think will end up being approved. Then we’re going to be facing issues about sequencing. Which antigen are we going to target first in the absence of anything other than cross-trial comparisons? Looking at response rates and saying maybe this is better or maybe this is not better is an example of how dangerous those cross-trial comparisons can be. Professor Kumar talked about daratumumab combined with teclistamab. The infection rate that they reported in that small cohort was actually lower than [with] teclistamab alone, which of course defies common sense. You have to be a little bit careful with that information. But the bottom line is I think it’s great. We’re going to have a lot, but it’s going to be frustrating in terms of what are we going to do with all the bispecifics we’re going to have. I’m glad to have the problem, believe me.
Rafael Fonseca, MD: Thank you. It’s the time of optimism for me. It’s not even the glass half empty or half full; it’s like the pitcher is half full. That’s what we have. Dr Cook, your parting thoughts?
Joselle Cook, MBBS: Yes, I think that I endorse everything Dr Gertz and Dr Kumar said. I would just add this. While bispecifics are going to be taken up much rapidly in the community practice over the next few years, I would just advise caution to ensure that we don’t miss basic things. Make sure patients are on the proper antimicrobials, make sure we don’t miss infections while we figure out the correct dosing and the correct dosing schedules, and we need to make sure they have adequate supportive care.
Rafael Fonseca, MD: Thank you. Well, I knew going into this session that it was going to be very, very informative and fun. This beats my expectations wildly. I know that for so many of the topics, we could have gone on to discuss [them] for half an hour, an hour, or more. Hopefully, this will be a practical way for all the audience to understand how we’re thinking about bispecifics with a special emphasis at our institution at the Mayo Clinic. I’m going to thank our panelists, Drs Cook, Kumar, and Gertz for, again, a very rich and informative discussion. Also, to our viewing audience, thank you for joining us. We really hope you found this Cancer Network Training Academy session, entitled Institutional Perspectives from Mayo Clinic: Implementing Bispecifics in Practice, to be useful and valuable as you treat your [patients with] multiple myeloma. Again, thank you for your interest.
Transcript edited for clarity.
