Advance Planning Eases Bispecific Therapy Burden for Patients

Community oncology practices are steadily expanding use of bispecific antibodies for relapsed/refractory multiple myeloma (MM), with real-world data showing uptake among eligible patients climbing from 5% in 2022 to 73% by mid-2025.¹ Yet lingering hesitancy around the adverse effect profile for the therapy class, along with regulatory and infrastructure hurdles, continues to slow adoption outside academic centers, according to Swarup Kumar, MD, assistant professor of medicine in the Division of Hematology and Medical Oncology at UConn Health.²

Hesitancy Around Bispecifics in the Community

Although use of bispecifics in the community is increasing, Kumar said there remains a hesitancy toward the use of bispecific antibodies in community practice, rooted largely in the adverse event profile that accompanies the therapy. Cytokine release syndrome (CRS) and immune effector cell–associated neurotoxicity syndrome (ICANS) remain the primary toxicities clinicians must anticipate during step-up dosing, and Kumar said the burden can feel overwhelming for oncologists managing patients with multiple comorbidities outside a specialized center.

That tension echoes a recent AJMC Stakeholder Interchange in Seattle, Washington, where panelists described Risk Evaluation and Mitigation Strategies (REMS) certification, electronic medical record fragmentation between community and hospital systems, and a shortage of trained infusion staff as persistent barriers to bringing bispecific antibodies closer to patients' homes.³ Community pharmacy departments in particular described REMS compliance as a steep climb given more limited staffing than academic centers.

Closing that gap, Kumar said, requires deliberate investment in education and cross-institutional relationships.² He pointed to a growing need for "partnership between academic and community centers" to enable safe administration outside specialized hematology units.

Why Are Outpatient Dosing and Tocilizumab Central to Wider Access?

Kumar's program at UConn Health is moving toward outpatient administration of bispecific antibodies, a shift he said can ease the burden on community centers without hospital affiliations and on patients who are reluctant to be admitted for several days. The strategy is gaining traction nationally: findings from the phase 2 OPTec/OPTal trial (NCT05972135) showed no grade 3 or higher CRS or ICANS events among patients who received prophylactic tocilizumab before outpatient bispecific treatment, supporting broader community-based dosing of agents such as teclistamab-cqyv (Tecvayli) and talquetamab-tgvs (Talvey), both from Johnson & Johnson.⁴ A separate multicenter analysis similarly found that a single prophylactic dose of tocilizumab, given before the first step-up dose, was associated with CRS and ICANS rates of just 10.1% and 5.9%, respectively, without diminishing treatment response.⁵

Kumar credited prophylactic tocilizumab with significantly lowering CRS and ICANS risk in his own patients,² aligning with a broader clinical consensus that outpatient step-up dosing, paired with structured monitoring, can be implemented safely when supported by a trained multidisciplinary team.⁶

Even so, not every patient prefers the outpatient route. Kumar has had patients tell him they preferred to stay in the hospital for a week because it would ease the burden of going in for repeated visits and monitoring.² He said that preference has worked in favor of some patients, underscoring that flexibility, not a single delivery model, is often what best serves a diverse patient population.

How UConn Health Plans Financial and Logistical Support in Advance

Kumar's team identifies candidates for bispecific antibody therapy well before treatment begins, discussing high-risk patients during team meetings that include social work and supportive care staff.

As a state institution, UConn Health offers a charity care model, and Kumar said his program has also collaborated with outside foundations to help prepare patients financially and logistically ahead of therapy. More recently, that has included a partnership with the International Myeloma Foundation, a national nonprofit that connects community and academic centers to expand patient education and resources, including through its M-Power Initiative focused on underserved populations.⁷

For situations that require rapid initiation of therapy, Kumar said hospital admission remains the most reliable path until a patient's individual resource needs can be assessed and addressed.

What Do Approvals Beyond Myeloma Mean for Community Readiness?

Kumar noted that bispecific antibodies are no longer confined to myeloma. Tarlatamab-dlle (Imdelltra; Amgen), a DLL3-targeted bispecific T-cell engager, received full FDA approval in November 2025 for extensive-stage small cell lung cancer, becoming the first bispecific antibody approved for a solid tumor.⁸ With additional bispecific antibodies advancing in other cancer types, Kumar said readiness to manage adverse events and the infrastructure to support it will need to extend well beyond myeloma specialists and into a broader swath of community oncology.²

As real-world uptake data continue to show steady growth in the community setting, the strategies Kumar described, prophylactic tocilizumab, outpatient protocols, early multidisciplinary planning, and foundation partnerships, may serve as a template for other cancer types now entering the bispecific antibody era.

References

1. Steinzor P, Zackon I. Bispecific antibodies for multiple myeloma in community oncology are on the rise: Ira Zackon, MD. AJMC^®. December 9, 2025. https://www.ajmc.com/view/bispecific-antibodies-for-multiple-myeloma-in-community-oncology-are-on-the-rise-ira-zackon-md
2. Shaw ML, Kumar S. Bringing cutting-edge MM therapy to every patient: Swarup Kumar, MD. AJMC. June 30, 2026. Accessed September 3, 2026. https://www.ajmc.com/view/bringing-cutting-edge-mm-therapy-to-every-patient-swarup-kumar-md
3. Overcoming pain points to advance bispecifics in the community for patients with myeloma. AJMC. December 23, 2025. Accessed September 3, 2026. https://www.ajmc.com/view/overcoming-pain-points-to-advance-bispecifics-in-the-community-for-patients-with-myeloma
4. Conroy R. Tocilizumab supports outpatient bispecific antibody use in multiple myeloma. CancerNetwork. May 31, 2026. September 3, 2026. https://www.cancernetwork.com/view/tocilizumab-supports-outpatient-bispecific-antibody-use-in-multiple-myeloma
5. Kowalski A, Lykon J, et al. Tocilizumab prophylaxis for patients with multiple myeloma treated with bispecific antibodies. Blood Adv. 2025;9(19):4979. https://ashpublications.org/bloodadvances/article/9/19/4979/538036
6. Garfall AL, Banerjee R, Frenzel L, et al. A roadmap to implementing outpatient administration of bispecific antibodies in multiple myeloma. Front Oncol. 2025;15:1630146. doi:10.3389/fonc.2025.1630146
7. M-Power. International Myeloma Foundation. Accessed September 3, 2026. https://mpower.myeloma.org/
8. Joszt L. Tarlatamab receives accelerated approval for extensive-stage SCLC. AJMC. May 16, 2024. Accessed September 3, 2026. https://www.ajmc.com/view/tarlatamab-receives-accelerated-approval-for-extensive-stage-sclc