ACCC Presents Survey Responses on Adoption of Bispecific Antibodies

Bispecific antibodies have been big news in the world of hematology for some time, ever since the 2014 approval of the first such therapy, blinatumomab, which targets both CD19 on the surface of B-cell lymphoblasts and CD3 on the surface of T cells.¹ The 2-for-1 punch of these novel immunotherapies can overcome limitations of conventional monoclonal antibodies.

In 2020, the Association of Community Cancer Centers (ACCC) created an ongoing education program to identify and address barriers to adoption of bispecific antibodies for the treatment of hematological malignancies. For this program, ACCC created a survey to better understand multidisciplinary cancer providers’ experiences with these therapies, with a focus on experiences with blinatumomab. Results of the survey were presented in an abstract during the 2021 American Society of Hematology Annual Meeting & Exposition.²

According to the abstract, the survey received 129 individual responses, with 66% of those reporting that they prescribed, dispensed, and administered blinatumomab and/or cared for patients being treated with it. Of these, 44% were medical oncologists/hematologists, 8% were advanced practice providers (APPs), 17% were nurses, 23% were pharmacists, and 9% fell into an “other” category of various other disciplines.

Provider experiences with blinatumomab varied; 92% of oncologists had experience with blinatumomab while only 35% of nurses reported this. Regarding community use, respondents said 59% of their institutions use it to treat relapsed or refractory acute lymphoblastic leukemia (ALL) and 41% use it to treat ALL with minimal residual disease positivity. Of note, 74% of oncologists said they use blinatumomab before chimeric antigen receptor T-cell therapy when deciding between the 2 options for patients with ALL.

The survey also found:

• 79% of providers are comfortable caring for patients treated with blinatumomab, but 59% identified barriers when caring for these patients.
• Challenges include transitioning patients from the inpatient to outpatient setting (41%), managing patients who live in remote areas (33%), securing insurance coverage (28%), managing adverse events (27%), helping patients address financial costs, (24%), and lacking in-house expertise with the drug (22%).
• Managing neurotoxicity and cytokine release syndrome was also reported as a challenge. Fewer than half of oncologists reported experience in this area, and only 6% to 9% of APPs reported having experience. Of note, 23% of nurses did not feel they had all the information needed to safely administer blinatumomab.
• 86% of respondents said written guidelines, best practices, and care recommendations would help. Requested resources included a list of home health pharmacies and agencies familiar with blinatumomab, care coordinators or navigators, best practices on care transitions, and information on outpatient administration.
• Expertise from the drug manufacturer and direct patient education were seen as beneficial, and 70% thought that peer support services for patients would also be helpful.

References

1. Mullard A. FDA approves first bispecific. Nat Rev Drug Discov. 2015;14(7). doi:10.1038/nrd4531
2. Atembina L, Boehmer L, Terrell K, et al. Multidisciplinary provider insights to promote adoption of bispecific antibodies to treat cancer in the community. Presented at: 63rd American Society of Hematology Annual Meeting & Exposition; December 11-14, 2021; Atlanta, GA. Abstract 4033. https://ash.confex.com/ash/2021/webprogram/Paper153794.html