An Argument for Outpatient Bispecific Antibody Delivery: Dr Kirollos Hanna

Bispecific antibodies remain a relatively new intervention for patients with multiple myeloma. They were not approved by the FDA until 2022, with teclistamab-cqyv (Tacvayl; Janssen Biotech, Inc.) making the first available treatment in this area.¹

In an interview with The American Journal of Managed Care^® (AJMC^®), Kirollos Hanna, PharmD, BCPS, BCOP, FACCC, director of pharmacy at Minnesota Oncology, spoke further to the utility and the benefits of implementing these therapies in outpatient care.

These subjects and more were explored at an Institute for Value-Based Care event co-hosted by AJMC and Minnesota Oncology.

This transcript has been lightly edited for clarity.

Transcript

Why is it important to start bispecific antibodies in the outpatient setting when possible?

Bispecific therapy, when you look at it, it's really changing the landscape of a lot of our hematologic malignancies, but not also just that, we are seeing bispecifics come to light in the solid tumor market. And there's a ton of ongoing clinical trials both in solid and hematologic cancers and we are anticipating a pretty robust portfolio of bispecific therapeutics.

They’re sort of the new therapeutic mechanism right now. And “new” might not be the most appropriate word as we've had some bispecifics for quite some time and some niche indications, but when you look at bispecifics, for example, in myeloma, they have completely changed the landscape of a penta-refractory population. The response rates that we see in a penta-refractory are nothing like we've seen before, so it's been a really exciting deliverable for these patients. Now, some bispecifics do come with an adverse event profile that is unique and there are some side effects of interest. Things like cytokine release as well as certain neurotoxicity. Because of that, the first exposure or the first few exposures to a particular bispecific requires monitoring, right? And right now, where we are, because people are fairly new to these concepts, there's not really good guidance as to: should you hospitalize the patient for the ramp-ups? Could you do it safely in the outpatient setting? While certain practices have been able to do that, others don't yet have the comfort or familiarity to start in that outpatient—fully outpatient—type of practice model.

So really the value here, if we're able to know how to navigate this, avoid adverse events—because the safety of your patient is going to be number 1—and we're able to develop out a program, let's say, through remote monitoring, through technology, through phone calls going out to patients, through proper patient and caregiver education, and we build the infrastructure to do all of this outpatient, there's a very attractive, you know, aspect that we can control cost, right? Your hospitalization and your admissions are going to drive up health care spend, right? And even the reimbursement of some of these therapies on the inpatient side might not be, you know, feasible because, again, there's a DRG reimbursement model vs how you reimburse for medications in the outpatient setting.

So, the value there is that we can reduce cost through remote monitoring, telemedicine, etc., and safely ramp up these patients in the outpatient setting. But again, you know there's been a lot of publications on this, a lot of educational deliverables on this. And I think as we become more and more familiar, it's very likely that in the next several years, many community oncology and many practices, in general, will have their own type of protocol in place to do outpatient ramp-ups.

Reference

1. FDA approves teclistamab-cqyv for relapsed or refractory multiple myeloma. FDA. October 25, 2022. Accessed January 24, 2025. https://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-teclistamab-cqyv-relapsed-or-refractory-multiple-myeloma