With bispecific antibodies moving into earlier lines of therapy for relapsed/refractory multiple myeloma, the central question for community practices is no longer whether to use these agents, but how to deliver them safely closer to home.1
"These studies [with bispecific antibody–based therapy] have demonstrated not only a progression-free survival [PFS] advantage as compared with the standard of care, but also an overall survival [OS] advantage," Roberto Mina, MD, an associate professor of hematology at Winship Cancer Institute of Emory University in Atlanta, Georgia, said during a recent OncLive® Scientific Interchange and Workshop. "We should make an effort to expand the access of these drugs to patients [who] are eligible and can benefit."
Mina co-moderated with Sara DiCamillo, PA-C, MPH, a physician assistant at Winship Cancer Institute, as community clinicians worked through cases on operationalizing bispecifics and on financial and access considerations.
In March 2026,
Mina noted that patients with prior daratumumab exposure, but not refractoriness, still benefited. Teclistamab monotherapy is currently approved as monotherapy for patients with relapsed/refractory multiple myeloma who have received at least 4 prior lines of therapy, including a proteasome inhibitor, an immunomodulatory agent and an anti-CD38 monoclonal antibody.4 Notably,
Emerging data on earlier-line bispecifics, along with the approvals of earlier-line CAR T-cell therapy, have prompted key sequencing questions for patients in the early relapse setting.
"If a patient is fit enough to receive CAR T[-cell therapy] and is willing to accept the risk of delayed toxicity, and I have a good bridging therapy…I would definitely recommend CAR T-cell therapy first [before a bispecific antibody–based regimen." Mina said, noting that teclistamab plus daratumumab, "is not as a B option, but a great option."
Community data presented during the workshop supported outpatient approaches. In a Cardinal Health network cohort (n = 71), outpatient or hybrid step-up dosing with teclistamab yielded an ORR of 77.5%, with any-grade CRS occurring at a rate of 26.8% (grade 3, 2.8%) and any-grade ICANS reported at a rate of 4.2%.6 In a OneOncology cohort (n = 23), 70% of patients treated with teclistamab (n = 13) or talquetamab-tgvs (Talvey) completed step-up dosing without hospitalization.7
In the phase 2 OPTec trial (NCT05972135), prophylactic tocilizumab (Actemra) before the first teclistamab dose at 15 community sites resulted in grade 1 CRS in 8.9% of patients and no ICANS.8
"In my view, every patient is eligible [for a] bispecific antibody," Mina said. "Now the question is: Is the patient eligible for an outpatient administration? Again, I think that patient fitness for sure matters. What is most important is actually the presence of a caregiver who can take care of patients [and] contact the center if there is such a need.”
DiCamillo said that at Emory, giving all patients prophylactic tocilizumab before the first dose meant, "we went from about 75% to 15% of patients having CRS." Patients stay within 30 minutes of the center with dexamethasone, acetaminophen, and diphenhydramine at home. Because prophylactic tocilizumab is included in NCCN guidelines, coverage has not been an issue, she added.
Practices without a 24-hour care center described the emergency department as the weak link.
"Our biggest challenge is the lack of having a 24-hour care center, so we have to rely on emergency rooms for after-hours care," said Mary Ninan, MD, of Georgia Cancer Specialists.
Adam Kotkiewicz, DO, of Cancer Centers South Florida, described difficulty securing beds at unaffiliated hospitals.
Faculty recommended wallet cards, chart notes flagging step-up dosing, paging pathways to the treating team, and weekday dosing schedules. Daniel Castro, MD, of Mid Florida Cancer Centers/AdventHealth, suggested starting by integrating a single bispecific antibody into practice to allow the entire staff to become fluent in its management.
Infection prevention was framed as nonnegotiable.
"There cannot be, in any practice, a bispecific antibody given without IVIG," Mina said. "I always tell the patient that it's a package."
Attendees cited limited 24-hour coverage, educating emergency staff across hospital systems, insurer scrutiny of prophylactic tocilizumab and IVIG, and the cost of home monitoring equipment, as well as missing data in daratumumab-refractory disease and on sequencing with CAR T-cell therapy.
"We should not overcomplicate something that should not be that complicated," Mina concluded.
