How Can Bispecific Antibodies Become More Accessible in Community Settings?

At the 2025 American Society of Hematology (ASH) Annual Meeting and Exposition, results from a retrospective, observational cohort study showed that, following regulatory approvals, bispecific antibodies were experiencing rapid uptake and steady growth in patients with relapsed/refractory multiple myeloma in community settings. The presenting study author, Ira Zackon, MD, senior medical director at Ontada, spoke with CancerNetwork® at the conference about these results.

In the poster, it was notably highlighted that among patients receiving bispecific antibodies, approximately one-fifth were in community rural clinic settings. After being prompted about this finding, Zackon highlighted that there can be larger community settings that are able to dedicate some hematologists/oncologists to learning about bispecifics, but he also noted that smaller clinics may need to rely on partner hospitals.

The study included patients with active relapsed/refractory multiple myeloma who initiated either teclistamab-cqyv (Tecvayli), talquetamab-tgvs (Talvey), or elranatamab-bcmm (Elrexfio) between October 1, 2022, and July 14, 2025.

Transcript:

CancerNetwork: Almost one-fifth of patients were receiving bispecific antibodies in a rural setting. What can be done to further improve access to treatment with these agents in a rural location?

I would say that what we’ve learned about integrating bispecifics into a community-based practice is that, first of all, there will be those practices that can be early adopters. They may be community [institutions], but may be of a larger size, with a larger number of hematologists/oncologists whom you could dedicate a select few to really be experts in delivering these therapies and having a team around them within the practice. You also have to educate other providers who may need help at the hospital side, for example, the emergency room or intensive care [unit]. This is truer of CAR T-cell therapy in terms of the severity of the immune [adverse] effects, although they overlap with bispecific antibodies. Again, you still have to have the resources and the practice to be able to then stand up what you need to in terms of delivering this therapy safely.

It’s important that we know that, in order to provide our full spectrum of patients [with multiple myeloma] who may be eligible to have access, [bispecific antibodies] need to be delivered at the community setting, not just at academic centers, because patients can’t always get there, and that’s a shame. The rural setting just adds another level because there may be smaller offices, which could be a challenge in and of themselves. You do need to have a partner hospital that is educated and that you know you can rely on for managing these patients. [However,] it is possible to outsource, in some ways, the initial dosing, which we call step-up dosing, to get through the phase where most of the severe adverse reactions like cytokine release syndrome and, less commonly, neurotoxicity events occur. Then, [we can resume] their care through the ongoing maintenance full-dose phase, where you don’t tend to see those aspects of the [adverse] effects, although you still have to be managing other issues, especially infections, which are increased over the course of therapy. But that’s more in the wheelhouse of even a general hematologist/oncologist.

Reference

Whitesell M, Su Z, Herms L, Espirito J, Paulas J, Zackon I. Evolving real-world uptake and patient characteristics of bispecific antibodies in relapsed/refractory multiple myeloma: insights from a US community oncology network. Blood. 2025;146(suppl 1):5857. doi:10.1182/blood-2025-5857