Retrospective Study Highlights Real-World Uptake of Bispecific Antibodies in R/R Multiple Myeloma

A real-world observational study of bispecific antibodies in relapsed/refractory multiple myeloma in the community oncology setting demonstrated the growing rate of their use in clinical practice, according to Ira Zackon, MD.1

The retrospective observational real-world study included adult patients with relapsed/refractory multiple myeloma who had started on bispecific antibodies or were previously treated with at least 5 lines of therapy without a bispecific antibody. Findings showed that in 2023, 44.67% of evaluable patients (n = 253) received a bispecific antibody. Prior to the July cutoff data, 54.32% of those patients treated in 2024 (n = 162) received 1 of these agents.

In an interview with OncLive® at the 2024 ASH Annual Meeting, Zackon discussed the rationale of the real-world analysis, potential differences between real-world and trial patient populations, the real-world data for the uptake of bispecific antibodies, and the next steps for research.

Zackon is a hematologist oncologist in the Department of Medicine with the Albany Med Health System and senior medical director at Ontada in New York.

OncLive: What was the rationale of the real-world study evaluating bispecific antibodies for relapsed/refractory multiple myeloma?

Zackon: We have seen such a transformation of [multiple myeloma] treatment prolonging and improving lives. [Recently], new entrants into our therapies are called bispecific antibodies. These are antibody treatments that can target both the myeloma cell and [send] T cells directly to the tumor. That's basically how it works.

The first [FDA] approval [of an bispecific antibody in multiple myeloma] was in October 2022 for teclistamab-cqvy [Tecvayli]. Now we have 3 [FDA-approved] bispecific antibodies, [including] elranatamab-bcmm [Elrexfio] and talquetamab-tgvs [Talvey]. They target some different proteins, [which is how] they get directed to the myeloma cells. Since these are new therapies, they can be complex to deliver.

This [real-world observational study], to my knowledge, is the first high-level look at the utilization of bispecific antibodies in [patients with multiple myeloma] at the real-world community oncology setting outside of academic centers.

How did this real-world patient population differ from the clinical trial population?

This was a very high-level population-based view. We only used what we call structured data within an electronic health record [her]. These [data were from] the US Oncology Network, so a very large network of practices that use this EHR. We looked at the period of time from October 2022 with the first approval, up until July 2024. We looked for patients with multiple myeloma who either had bispecific antibody therapy delivered or had at least 5 lines of therapy because this is currently where bispecifics are used—patients have to have at least 4 lines of therapy.

We found 564 patients overall: 202 had received bispecific antibody therapy, and the remaining 362 had received [other therapies]. When we looked at that population, we [focused on] those who received it and those who didn't receive it. In terms of utilization, when we look at the first full year, 2023, 45% of the patients in this group received bispecifics. When we look at 2024 up until July, at least proportionally, it was up to 54%. At least we're seeing a fairly significant utilization of bispecific antibodies, which is very encouraging to see at the community level so that patients have full access to these therapies.

When we looked at the patient characteristics, we could see that those who received bispecifics tended to be a bit younger. Also, when you look at performance status, those who might be more frail because of other health issues would have a lower performance status or a less favorable one. There were only 9% of patients in the bispecific arm who had an ECOG performance status that was over 1, which is starting to become less favorable, whereas an [ECOG performance status over 1] was 24% in those [not treated with bispecifics], so there seemed to be some differences in at least the patients that were selected for it. Those who could receive a bispecific antibody therapy generally reflect the population of patients who were treated in prospective trials.

When we looked at other factors, we did not see any differences in sex or, importantly, race. For example, we know that myeloma occurs with increased incidence in the population of Black patients, who represent approximately 15% of the population. Black patients were receiving bispecifics equally to not receiving bispecifics, and equal to others in the [overall] population. That was good to see. [The Black population] is often underrepresented in prospective trials.

Based on findings from these real-world data, what are the next steps in research?

The next steps are going to be doing this analysis with more time, perhaps over another couple of years, to more fully see the patterns of care with the bispecific antibodies in a larger population. Importantly, our database is now much more enriched, not just in these structured data, but we have been able to move unstructured data, which is what occurs in a visit note or an attached document, which you generally have to look at. We've been able to use technology and artificial intelligence to take unstructured data into a structured data platform. It's been validated, and we have human abstractors making sure it's valid, as well as bringing in other elements.

The next iteration of this [analysis] will look much more deeply at those patients who got the bispecifics and the safety experience. We can begin to look at outcomes, and start to talk about, ‘How does the real-world data compare [with] what we saw in prospective data?’

It's always important to have that follow-up because the real-world patients are our everyday patients—they're not as selective. Whether that be simply by health or their ability to get to a clinical trial, we know only a relatively small percentage of people get into clinical trials, and it doesn't always represent the [diversity] of America in terms of the patients we see. Therefore, we look forward to reviewing this type of analysis with even more data to give us a better, deeper understanding.

Reference

Herms L, Su Z, Paulus J, et al. Real-world utilization of bispecific antibodies for treatment of relapsed/refractory multiple myeloma in the US community oncology setting. Blood. 2024; 144(suppl 1):2410. doi:10.1182/blood-2024-208825