Why Caregivers Are Critical During Bispecific Step-Up Dosing

Ralph V. Boccia, MD, FACP, founder of The Center for Cancer and Blood Disorders, clinical associate professor at MedStar Georgetown University Hospital, and medical director of the International Oncology Network Clinical Research Program, discussed the role of caregivers for patients receiving bispecific antibodies and how that support compares with what is required for chimeric antigen receptor (CAR) T-cell therapy.

Boccia explained that bispecifics require a caregiver, although for a shorter period, because the greatest risk occurs during the step-up dosing phase. He noted that the timing of cytokine release syndrome (CRS) differs by disease: patients with multiple myeloma typically experience it during the early step-up doses, whereas patients with lymphoma typically experience it with the first full dose. Caregivers are educated on this critical window and are expected to monitor the patient’s mental status, blood pressure, pulse, and oxygen saturation during the 48 hours around each step-up dose, recording the data to share with the care team at follow-up visits. Their job, he emphasized, is to report, not to interpret.

Transcript:

Boccia: They require a caregiver, and it is for a shorter period. It’s during the step-up process that a patient getting bispecifics is at the biggest risk and depending on whether it’s a patient with multiple myeloma or a patient with lymphoma, we know when during step-up that risk might occur. A patient with multiple myeloma typically gets [CRS] with the first doses, and it might take 3 or 4 doses to get all the way up, whereas a patient with lymphoma typically gets it with the first full dose. Understanding those things is part of the educational process, and we want to make sure the caregiver understands that’s the critical time.

It’s the 48 hours around each of the step-up doses when they’ve got to be paying attention to the patient’s mental status, monitoring their blood pressure, pulse, and oxygen saturation, and recording those things. Then, when we see the patients the next day, or see them twice a day for a couple of days during each of the step-up dosing weeks, they can report and show us what the data look like. We don’t expect them to interpret it; we expect them to report it.