Step-Up Dosing Practices for Bispecifics in Multiple Myeloma

This is a video synopsis/summary of a Peer Exchange featuring Krina K. Patel, MD, MSc; Amrita Krishnan, MD; Caitlin Costello, MD; Saad Z. Usmani, MD, MBA, FACP; and Rafat Abonour, MD.

The discussion focuses on real-world logistic considerations around administering B-cell maturation antigen (BCMA)–targeted bispecific antibodies. Initially, step-up dosing was done in an inpatient setting, but programs are transitioning to outpatient administration. However, inpatient administration remains standard for patients with high tumor burden who are at risk of cytokine release syndrome (CRS). Outpatient administration requires significant infrastructure and resources to monitor for CRS given substantial patient and caregiver burdens. Using bispecifics earlier when disease burden is lower may enable more outpatient treatment.

All panelists have both teclistamab and elranatamab available to allow flexibility for combinations or individual patient factors. The schedules are de-escalated quickly from weekly to monthly dosing based on response and tolerability to reduce infection risk and other toxicities. However, sporadic patients seem to maintain a response despite stopping treatment early due to toxicity, supporting further study of de-escalation strategies.

Video synopsis is AI-generated and reviewed by OncLive® editorial staff.