Expertise Is Essential to Bispecific Access for Patients With Acute Leukemias: Amir Fathi, MD

Amir Fathi, MD, a leukemia specialist and academic oncologist at Massachusetts General Hospital, has built his career around developing clinical trials for patients with acute leukemias and bone marrow cancers, as well developing novel therapies in acute leukemias. His dual roles as researcher and practicing oncologist allow him to bring cutting-edge treatments directly to patients, both in clinic and rounding on the inpatient leukemia service.

In this first part of an interview with The American Journal of Managed Care^®, Fathi discusses one of the biggest nonfinancial barriers to bispecific therapies: the expertise required to safely administer and manage them. He emphasizes that this expertise is essential to ensuring patients can fully benefit from these advanced treatments.

Fathi was a panelist at the recent Institute for Value-Based Medicine^® event in Boston, on the discussion, “Optimizing Care Models for CAR T and Bispecifics: Addressing Cost, Infrastructure, and Access Challenges.”

This transcript has been lightly edited for clarity; captions were auto-generated.

Transcript

Beyond cost, what are the biggest nonfinancial barriers preventing eligible patients from accessing bispecifics, and how can care models address these?

First of all, I will start broadly. I will say expertise. When we talk about bispecific therapies—and for us really right now, in terms of standard, conventional care, it’s blinatumomab for patients with acute lymphoid leukemia—treating patients with blinatumomab requires expertise in terms of tolerability, in terms of safety, in terms of monitoring for and recognizing adverse events that are unique to these agents, in terms of how to manage treatment outpatient and in clinic; when patients need to come back, what instruction and guidance to provide them; and what management approaches are there to address adverse events were they to arise. Expertise, more than anything, I think is important in bispecifics and probably more so with CAR [chimeric antigen receptor] T cells. As of now, most of that expertise, at least in my own humble opinion, resides in academic centers, which see a lot of patients for whom these bispecifics are available—at least with leukemia. I can’t speak about other cancers, but for leukemias, that is the case.

Where does expertise come from? Expertise comes from experience. It comes from knowledge. It comes from a group of people who treat the same disease and can communicate with each other. It comes from education, reading, and going to conferences, and if that is lacking, either because you don’t see enough acute lymphoid leukemia or because you're not surrounded by a place that provides that type of scenario commonly and provides the support that you need to get through it, it can have an impact on patient care. When you ask beyond cost, I would think that the most important potential area of need would be expertise when it comes to these novel therapies.