Real-World Utilization of Bispecific Antibodies for Treatment of Relapsed/Refractory Multiple Myeloma in the US Community Oncology Setting
Authors: Herms Lisa , Su Zhaohui , Paulus Jessica , Zackon Ira 
Published: December 2024

Background: The treatment landscape for relapsed/refractory multiple myeloma (rrMM) has continued to rapidly evolve in recent years, including with the advancement of bispecific antibodies (BsAbs). Following the approval of teclistamab-cqyv in in October 2022 and the approval of two additional BsAbs in August 2023, there are now three BsAbs that are considered preferred options by the NCCN for rrMM after at least four prior lines of therapies. However, there currently are not robust data on the real-world utilization of BsAbs following their approvals. The purpose of this study was to address this gap by describing the uptake of BsAbs and characteristics of patients receiving BsAbs in a large network of community oncology practices in the US.
Methods: This was a retrospective observational study of adult patients with active rrMM who initiated a BsAb or received at least five lines of therapy (5L+) without a BsAb from 10/1/2022 to 7/24/2024. Patient characteristics and treatments were collected from structured data fields in iKnowMed™, an oncology-specific electronic health record system that captures outpatient practice encounter histories for patients seen in The US Oncology Network and selected non-Network practices. Patient characteristics were descriptively summarized at time of initiation of the BsAb (or eligible non-BsAb therapy as 5L+) (index). No statistical comparison between the cohorts was conducted.
Results: A total of 564 patients were identified, including 202 who received BsAb and 362 with non-BsAb therapy. The most commonly observed BsAb was teclistamab (received by 183 patients, 91% of the BsAb population), followed by talquetamab (n=28, 14%) and elranatamab (n=6, 3%). In 2022, only one patient initiated BsAb, compared to 148 (99%) with non-BsAb treatment. In 2023, this increased to 113 (45%) with BsAb vs. 140 (55%) without, and in 2024 more than half of patients initiated a BsAb (54% vs. 46% without). Median (range) age at index was 69.5 (40, 89) years for the BsAb cohort and 73 (37, 90+) years for the non-BsAb cohort. Half of patients in the BsAb cohort were ≥70 years (50%), one-third were between 60-69 years (36%), and the remainder were &lt;60 years (14%). Almost two-thirds of the non-BsAb cohort were ≥70 years (65%), and only 11% were &lt;60 years. There was no difference in proportion of male and female patients in the BsAb cohort (50% each), and there were slightly more males receiving non-BsAb treatment than females (56% vs. 44%). Most patients were White (71%), 15% were Black, 5% were of other race groups, and 9% did not have a documented race. Among patients with documented race, the proportion of White patients was the same across the two cohorts (78%); the BsAb cohort had slightly more Black patients (18% vs. 16%) and fewer patients of other race groups (4% vs. 6%). Most patients were located in an urban setting (85% of the BsAb cohort and 90% of the non-BsAb cohort). The geographic distribution of patients was relatively even between the South (37% of the BsAb cohort and 39% of the non-BsAb cohort), West (30% and 28%) and Midwest (29% and 20%), with few patients in the Northeast (5% and 12%). ECOG was undocumented for almost half of all BsAb patients (49%) within 3 months from the index date, but for those patients with a documented score, an ECOG of 1 was most common (n=73, 70%), followed by 0 (n=22, 21%), with scores &gt;1 less common (n=9, 9%). ECOG was less frequently documented among the non-BsAb cohort (62% unknown), but when available the most common score was also an ECOG of 1 (n=75, 55%). ECOG scores &gt;1 were more common (n=33, 24%) and scores of 0 were less frequent (n=28, 21%).
Conclusions: This study showed rapid initial uptake and then increasing utilization in the community oncology setting following the approval of the first BsAbs for rrMM, a promising sign for when such novel treatments enter the market, even with additional resource demands for safe administration. Characteristics of patients receiving BsAbs were generally in line with broader rrMM population statistics. As the first analysis of the real-world uptake of BsABs in a national network of community practices, findings from this study set the stage for a more in-depth analysis of characteristics of patients receiving these treatments compared to those who do not, as well as longer-term outcome analysis when sufficient follow-up is available.