Impact of Bispecific Antibodies on Treatment Patterns and Patient Characteristics in Multiple Myeloma

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Lisa Herms, PhD: Hi, my name is Lisa Herms. I'm an associate director of real-world research with Ontada. I've been with the company about 4 and a half years. Two of those years, I was a research scientist leading real-world research (RWR) studies with their life sciences partners and I currently oversee a team of research scientists. Prior to this role, I was also working in the RWR space, specifically focusing on electronic health record (EHR) based research and academically my background is in economics and health economics.

All right, excellent. Could you share a brief overview of your research evaluating the real-world utilization of bispecific antibodies (BsAbs) for the treatment of relapsed/refractory multiple myeloma (rMM) in the US community oncology setting? 

Dr Herms: Yeah, so this was a retrospective observational cohort study that looked at the real-world utilization and uptake of bispecifics for the treatment of relapsed refractory multiple myeloma, specifically focusing on the community oncology setting. Since the first approvals of bispecifics in 2022, there are now 3 agents available that are preferred treatment options for patients, after at least 4 prior lines of therapy, but there really hasn't been a lot of real-world research into the true uptake and experience of these therapies, specifically in the community oncology setting. And there have been some concerns around how this plays out in practice, just due to some of the clinical and operational resource demands that the safe administration of these therapies require. We were interested in taking a look at this experience again specifically in the community setting, which is quite different. 

We looked at about 500 or so multiple myeloma patients receiving treatment since the first approvals of bispecifics in 2022. We divided up the cohort into patients that did receive bispecifics and patients that could have received them but did not and we looked at just some descriptives around uptake, utilization patterns, patient characteristics. And we found that there actually was quite a rapid uptake in a very short amount of time. Our study stands from October 2022 through July 2024. But even with a very short time period, there are a lot of patients receiving bispecifics. 

We also looked at the patient characteristics between the 2 cohorts, and we found the patients receiving bispecifics tended to be a little bit younger and had a better performance status directionally compared to those who did not receive bispecifics, which was quite an interesting signal as well. This was kind of the first step in what I hoped to be a long research project as we're monitoring the uptake over time, deep diving into those patient characteristics, eventually looking at outcomes, but just really interesting signals that this study showed about the uptake of something that is quite difficult to implement in practice, so there are promising findings there in the community settings specifically. 

What were the most important findings of your study regarding the characteristics of patients who received BsAbs for rrMM compared to those who did not receive?

Dr Herms: Yeah, so we had a total about 564 patients, 200 or so of those that received bispecifics. It was, over time, a fairly even split, although that changed over time. We just did a very high-level descriptive analysis of some baseline patient characteristics. A lot of times the characteristics were similar or comparable across the groups, but we did find that patients in the bispecific cohort did tend to be a little bit younger at index, and they did tend to have a slightly better Eastern Cooperative Oncology Group (ECOG) Performance Status as well than those in the non-bispecific cohort. We did not do statistical testing on this in just a descriptive high-level study, but there are some interesting signals here that I think are quite aligned with just expectations about when new therapies enter the market and what are the patients that are going to be getting those therapies early on. 

We're interested in monitoring how that evolves over time with the hypothesis being that over time the demographics of the patients receiving bispecifics are going to be more closely aligned with just the broader patient characteristics as well. We'll see in older patients, patients before they start performing status as well, getting them just as the experience in clinical practice grows.

Always more room for research, right? 

Dr Herms: Always, yes.

What factors do you believe may have contributed most to the increasing utilization of BsAbs among patients over the study period? 

Dr Herms: I think there was a lot of excitement in the field around these new therapies that are available treatment options for these patients. We did see a decent amount of uptake, but the uptake still is going to take some time. I think there remain some barriers to this becoming sort of the full standard of care over time, just because there are some clinical operational considerations. There are additional resource constraints that administration of this kind of therapy takes on providers and so I think as the experience sort of grows, as physicians are more comfortable with this, as patients are more comfortable with this, we will continue to see an uptake over time. But it was quite encouraging to see that this happened even within the year and a half, the first approvals. 

In your opinion, what are the key implications of the growing utilization of BsAbs for rrMM patients in terms of treatment outcomes and potential improvements in the overall care and management of this disease?

Dr Herms: I think findings are really promising, so we did not yet look at outcomes. We will need some additional follow-up data to be able to really assess how this is impacting ultimately patient survival or patient outcomes. But the fact that these therapies have been approved, their preferred treatment, they're actually being used, is quite encouraging. I think we're all very hopeful that this will ultimately impact and improve the patient lives as well. 

I think there will be a learning curve. Again, these therapies, there's very specific requirements in terms of how to administer them, how to monitor the patients as they're receiving this treatment. And there's a slight change in how providers are needing to approach these patients and treat these patients. We'll see how that plays out. But we're quite hopeful that, again, as they develop the experience, as they develop a playbook and learn from each other and engaged in strategic partnerships, that it'll improve the overall continuity of care, the quality of care, and then the outcomes. 

What are the next steps for further research in this area, and how do you hope your findings will impact future decision-making and clinical practice in the field of rrMM treatment?

Dr Herms: I think the first step will be just to continue to monitor the uptake over time. We cut off our data in July of 2024. Our data is real-time so we're continuing to monitor how the utilization, the types of drugs are being used, how that changes over time, and that longer follow-up will result in bigger sample sizes. And statistically, there's a lot you could do the bigger sample size gets. We're hoping to do a deep dive into the patient characteristics, specifically comparing the ones who do and don't receive biospecifics and ultimately try to figure out why are the patients who are not getting the biospecifics, why are they not getting them? Is that related to patient characteristics? Is that related to practice characteristics or treating physician characteristics? I think that's an area that we're quite interested in exploring. 

Outcomes certainly would be the second piece that we're looking at once we have the follow-up data—looking at how the therapies in the real world are actually impacting survival rates, response rates, and things like that. And then I think the third area that we want to deep dive into is that we saw a very rapid uptake, which is quite encouraging, making sure that continues to happen and better understanding the potential barriers to uptake as well. If we do end up seeing a plateau, which we have not seen yet and we don’t really expect to see. But if we do see that happening, understanding what are some of the barriers. Again, whether its physician-related or patient-related for the uptake and successful administration of these therapies for patients. Our research team is really excited about the promising signal that this is sending for this uptake, we're just really excited to keep working with the data and pulling insights from here because there's a real opportunity to improve outcomes, and improve how care is administered and received by patients. And, you know, this could be really important work that could really drive some decision-making at different levels. We are excited to continue it.