Integrating bispecific antibodies into community myeloma care: Challenges, insights, and educational impact Free

BACKGROUND: The integration of bispecific antibodies into community oncology practice offers promising therapeutic advancements but also presents substantial logistical, operational, and clinical challenges. As these agents are relatively new in the treatment landscape for multiple myeloma (MM), many clinicians have limited familiarity with the associated adverse events (AEs), and the evolving standards for optimal management. This multi-phase initiative draws from interviews with community-based practitioners and incorporates a targeted educational program aimed at equipping clinicians with best practices for identifying and managing adverse events linked to bispecific antibody therapies in the community setting.

METHODS: The first phase of this initiative involved in-depth interviews with three community-based hematologists/oncologists, aimed at evaluating current practice patterns, perceived barriers, clinical attitudes, and challenges in the management of MM. The second phase consisted of a 60-minute on-demand activity broadcasted on Medlive.com in October 2024. Expert hematologists/oncologists provided practical guidance on managing transitions of care between academic and community settings, addressed key inpatient and outpatient considerations, and reviewed team-based protocols for managing adverse events associated with novel therapies.

RESULTS: Among the three community oncologists interviewed, early-onset cytokine release syndrome (CRS) during the first treatment week emerged as a major challenge, primarily due to limited inpatient access and staffing constraints. Clinicians observed consistent CRS/immune effector cell-associated neurotoxicity (ICANS) patterns across bispecific antibodies, with nurses playing a critical role in real-time monitoring and early symptom detection. Patient and caregiver education remains central, supported by written guides and emergency action plans. Infection management remains the most difficult adverse event, with non-standardized use of intravenous immunoglobulin (IVIG) and inconsistent infectious disease consultation unless severe. Differences in infection severity between B-cell maturation antigen (BCMA)-targeting bispecific antibodies suggest a need for comparative safety data.

Operationally, remote monitoring is not widely used, though nurse-led outreach bridges this gap. Social workers and navigators are essential in overcoming financial and logistical barriers. Initial implementation of bispecific therapies required significant staff education, especially CRS grading and protocol development.

Challenges such as weekly dosing schedules, prolonged maintenance regimens, electronic health records (EHR) fragmentation, and limited access to specialists, particularly in rural settings, contribute to ongoing operational strain. Additionally, drug cost and the absence of inpatient support hinder initiation protocols like ramp-up dosing, limiting broader adoption of bispecific antibodies in non-academic environments.

A total of 1,808 clinicians participated in the educational program, 88% of whom were oncologists. The top 3 challenges cited in developing AE management protocols for MM included identify eligible patients who may benefit from therapy (22%), variation in care among different providers (18%), and no clinical pathway currently defined to recommend a bispecific antibody (17%). Post-activity data revealed that 45% of reported increased confidence in tailoring an AE protocol for patients receiving bispecific antibodies. Likewise, 42% indicated improved confidence in promptly recognizing and managing AEs associated with these therapies.

CONCLUSIONS: Successful implementation of bispecific antibodies in community oncology requires robust nursing leadership, standardized toxicity management protocols, enhanced infection oversight, and expanded infrastructure for monitoring and care coordination. Addressing systemic gaps—including access to inpatient support, referral efficiency, and affordability—will be critical to optimizing patient outcomes and sustaining the use of bispecific therapies in non-academic settings. Support was provided by an independent educational grant from Janssen Biotech, Inc.