My name is Dr. Adil Khan. I'm an assistant professor of medicine and public health at the University of Texas Southwestern Medical Center in Dallas. So this is an exciting real world study that we did looking at Toclistumab in real world settings treated all across the United States. We used the Flatiron database, which is a nationally representative oncology database with patients going all the way back to 2011. And we looked at any patients who had received the drug in either an academic or a community site from the date of the FDA approval in October 2022 all the way to the end of 2023. After we then split that cohort apart, we looked at some of the clinical, demographic, and outcome characteristics of the populations. We identified a little over 100 patients who had been treated in total. And by far most patients were treated in the academic setting, but with a notable fraction were treated in the community setting. To be clear, we used patients who had their index treatment as being academic or community as what labeled them as one or the other. From then what we saw of the characteristics of one population versus the other, we saw that patients were treated in the community setting overall quite successfully. So what we saw was that patients who were treated in the community were a little bit older, but they were not as sick as those in the academic site. We saw earlier ISS stages, we saw less extramedular disease, less lytic lesions, less renal failure, suggesting that overall as a population they were a little bit less sick, older but less sick. And overall their outcomes were actually a little bit better, maybe in part explained by that population difference. Now we had no, within the limitations of the data and the fact that the numbers were a bit small, we could not make claims that one was better than the other and that was not really the purpose of our study. But what we did show and wanted to show is that it's very feasible for patients to receive bi-specific antibodies, in this instance, to Clistamab specifically, in the community setting successfully. It is feasible to do so and we want to encourage our community practitioners to have more uptake. Well, for one, I think it's very important for the patient to have a good relationship with the provider to have the open discussion of when is the time appropriate to initiate an immunotherapy, whether it is a bi-specific antibody or CAR T therapy or maybe something else including a clinical trial. By and large, what we know from the reality on the ground is that community centers have limitations because of the REMS programs and some of the extra requirements that are needed by centers to administer bi-specific antibodies. And so there has been an impediment to uptake as a result of that. But I think an open conversation about when is the right time, what might referral look like and what might be a right time to initiate is what's going to be the best step. I think there, with the realm of immunotherapies and multiple myeloma, I think because it's a little bit above the newest frontier, there's a little bit of fear that goes into it. And we've seen that particularly more the CAR T side, those rates of some of the side effects, the cytokine release syndrome, the ICANN's neurotoxicity does create some pause. But we see much less of that in the bi-specific antibody space. And it's much more tolerable in general. And so we actually think that this is going to be a great thing as community sites are able to uptake those drugs more and more that really opens the doors for patients and ultimately serves them well.
HealthTree • January 13, 2025