Optimizing the Use of Bispecific Antibodies in Myeloma and Beyond: Prophylactic Measures

In this episode of OncChats: Optimizing the Use of Bispecific Antibodies in Myeloma and Beyond, Saad Z. Usmani, MD, MBA, FACP, FASCO, of Memorial Sloan Kettering Cancer Center, and Tarun Wasil, MBBS, FACP, of Northwell Medicine, discuss the need for continued evaluation of prophylactic treatments like tocilizumab (Actemra) and antimicrobial measures for bispecific T-cell engagers, noting logistical and financial challenges and the importance of collaboration with community centers.

Usmani: That’s absolutely appropriate and I appreciate the fact that there are practices that actually have started to do outpatient treatments; that’s excellent, actually. There are even some data about prophylactic tocilizumab, and I think we’ll just have to see how those data emerge and how we can logistically do this because I think that there will be some insurance coverage concerns [that we will be met with] along the way, as well. The only other thing that I would add is that antimicrobial prophylaxis, or VZV prophylaxis with acyclovir or valacyclovir, is something that we do across the board for patients. Unless a patient has consistently low neutrophil counts and/or a history of bacterial infections, typically we don’t give fluoroquinolones but that is a consideration. Then, for people who become hypergammaglobulinemic, along with having respiratory infections, we would think about giving IVIG every 4 or 6 weeks or so.

Wasil: Well said. I think we need to start with the prophylactic antibiotics and make a good connection with the community centers. Also, prophylactic use of tocilizumab, as you mentioned, is being studied. In one trial, which is in multiple myeloma with cevostamab, they did show that there was a marked decrease in the CRS rate after prophylactic tocilizumab. But again, it comes at the cost of financial toxicity, so we really need more guidance on that. Hopefully, we’ll get some data, maybe by ASH this year.