Outpatient Dosing of Teclistamab: Lessons From TecPIONEER 2.0
An expert highlights that outpatient step-up dosing of bispecific antibody therapy in multiple myeloma is feasible and beneficial for selected patients—with criteria like caregiver support, proximity to care, and low disease burden—supported by prophylactic measures and close monitoring to ensure safety while improving patient comfort and reducing health care costs.
Outpatient step-up dosing of bispecific antibody therapy in multiple myeloma has been shown to be feasible in several academic centers and recent clinical studies. Treating patients outside the hospital setting offers multiple advantages, including improved patient comfort, lower health care costs, simplified logistics, and reduced strain on hospital resources. However, outpatient treatment is not suitable for every patient. Careful patient selection based on specific criteria is essential to ensure safety during this process.
Key criteria for outpatient step-up dosing include having a continuous caregiver present with the patient and living within close proximity—ideally within 20 to 30 minutes—of a medical center to allow rapid access to care if needed. Additionally, patients should have a good performance status, typically an ECOG score of less than 2, and a relatively low disease burden at relapse. The severity of cytokine release syndrome (CRS) has been correlated with disease burden, so starting treatment earlier in relapse when tumor burden is lower can reduce toxicity risk. Prophylactic strategies such as administering tocilizumab or dexamethasone at symptom onset further support outpatient management by minimizing CRS severity.
Several institutions are developing outpatient models that include hospital-at-home services or remote patient monitoring. Patients are closely monitored for signs like fever, hypotension, or tachycardia, with protocols to prompt hospital admission if symptoms worsen. As familiarity with bispecific therapies grows among community oncologists, more patients may receive these treatments outside of specialized centers. Ongoing clinical trials are exploring earlier use of bispecific antibodies, including maintenance or frontline settings, which could further decrease toxicity by treating patients with lower disease burden. This evolving approach promises to expand access while maintaining safety and improving patient quality of life.
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