Insights from a community oncologist on myeloma bispecific antibodies | Ira Zackon, MD

I'm Dr. Ira Zakon. I'm a senior medical director with Ontario where we conduct what we call real world research. That's doing research on patients who are treated in everyday life, you know, in everyday clinics, which is different than those that go on what we call clinical trials where therapies are being tested and that's how we base FDA approval and that's how we the information we use when we're using these new therapies and talking to our patients. So it's important to go back to what we call the real world. I've also been a practicing hematologist for almost 30 years. So I'm here at the annual ASH, American Society of Hematology meeting, and I wanted to share some research we have done in patients who have multiple myeloma. So myeloma is a chronic disease of certain cells we call plasma cells are part of our immune system that accumulate in our bone marrow primarily, which is where our blood is made, and it can cause a variety of issues, low blood counts like anemia. It can affect the bone health and some patients have bone pains or sometimes fracture bones prematurely and so a variety of health issues that come with this disease. There are effective treatments, although they are not, they don't cure the disease yet. But there's a therapy that are called bispecific antibodies. So our immune system makes antibodies. These are proteins that help to clear infections for us. If we get a flu shot, we'll develop an antibody to that. People may be familiar with the COVID vaccines while you develop an antibody to try and protect you from these infections. Well, we can take antibodies and engineer them to target, in this case, myeloma cells, and it brings our immune system into how it actually controls the disease. It's not using chemotherapy. It's not using these other longer standing therapies. So, and our immune system is very powerful. And we're finally in the era of getting our immune system to do some work for us in combating our disease. So these are called bispecific antibodies because one part of the antibody attaches to the malignant myeloma cell and the other attaches to our own immune system, white blood cells called T cells, and it brings the T cell directly to here's where you have to go. So these are how they're there and they're very effective. The first approval was in 2022, and what we wanted to look at was the use of these bispecific antibodies, not in the academic university hospitals or the large hospital systems, but at the community level where, frankly, most people receive their care closer to home in the outpatient setting. And so we were looking at the use of bispecific antibodies. How has that gone since they were first approved? Because we know that it actually takes a practice, a lot of resource dedication to deliver these particular immune therapies safely. And so it's not for all practices yet. Our database looks at a large network of community practices. And what we saw year over year, was a steady increase in the use, which was encouraging. When you look at the first year, it was only at the end of 2022, so only about 5% of patients. But by 2025, it was up to over 70% of patients who might qualify for these were getting a bispecific antibody therapy. So it's at least indicating that it can be done in a community setting, although it still requires a lot of resourcing and it's going to take time for more broad ability to do that. Some encouraging things that we saw and it's important to mention is that myeloma is more common in black Americans and those of African ancestry. And often there's not enough representation of a black population in our clinical trials, and yet we're basing our results in our discussion. So we had approximately 19% black patients, 20% black patients. So that is what's fairly well represented, which is what you might expect at the community level where people get their everyday care. So I think that's an important aspect of what we saw. About 15% was delivered in a rural setting. So a smaller proportion, it's more challenging in a smaller office, rural setting. So that's going to take longer. But we know with these drugs, it's imperative that if our myeloma patients are more broadly going to get access to these effective therapies, it needs to be delivered closer to home because again, the average age of diagnosis is almost 70. So people are generally in their 70s or 80s living with myeloma and it's not always easy to travel and get to a distance if you have to. So it's imperative that we be able to do this close to home. And so this is the first analysis, at least in our database, to look at that. If our videos have helped you in any way, and you're able to, please consider making a donation to help us continue this important work. Your gift will go three times as far when we reach $500,000 by the end of the year. Every contribution, big or small, makes a difference and we're deeply grateful for your support.