Balancing Safety, Logistics in Multiple Myeloma Treatment Settings: Ameet Patel, MD

In this clip from last month’s Institute for Value-Based Medicine® event in Tampa, Florida, Ameet Patel, MD, of Florida Cancer Specialists & Research Institute, discusses which advanced multiple myeloma treatments, including chimeric antigen receptor (CAR) T-cell therapy and bispecifics, are best suited for inpatient vs outpatient delivery and the factors guiding that decision.

Watch part 1 to learn more about these treatment options.

This transcript was lightly edited; captions were auto-generated.

Transcript

Which treatments are best suited for inpatient vs outpatient delivery, and what factors guide that decision?

Ultimately, it comes down to logistics and access for patients. In CAR T-cell therapy, we infuse these CAR T-cells with the expectation that there are toxicities that may require hospitalization. Close proximity to hospitals is important due to the severity of side effects that may occur for patients, but, overall, if these side effects can indeed be manageable, and as patients are able to get through those with close observation by their provider and their cell therapy team, we find that a lot of patients don't require any further chronic therapy directed towards their myeloma.

That lends itself very well to a hybrid approach of outpatient and inpatient treatment, where patients can get their treatment outpatient. They're monitored very closely. There may be a remote monitoring system involved. If necessary, based on symptoms or lab parameters, a decision can be made to manage those side effects in a hospital setting, as well.

This is in contrast to bispecific therapy. To the largest extent, after they go through their induction piece, patients are able to manage most of their therapy outpatient. Bispecifics, in the first several doses for a patient, people can experience immune activation, like CRS [cytokine release syndrome] or neurotoxicity. For those reasons, oftentimes, by package insert or indications by trials, [patients] require very short hospitalizations.

So, it's a conversation at a patient and provider level to decide what is logistically more feasible for patients and what is best mirrored by their quality of life and their goals of care, too.