Keeping Patients on Multiple Myeloma Bispecifics: Beth Faiman, PhD

Advanced practitioner (AP)–led clinics can expand access to specialty care, and setting clear expectations about adverse effects can help patients with multiple myeloma stay on effective bispecific antibody therapy longer, according to Beth Faiman, PhD, MSN, APN-BC, AOCN, BMTCN, FAAN, FAPO, of Cleveland Clinic Taussig Cancer Institute. In an interview at the Patient-Centered Oncology Care® 2026 conference hosted by The American Journal of Managed Care_^® in Nashville, Tennessee, September 24-25, 2026, Faiman discussed AP-led models of care, managing taste changes with talquetamab, and infection prevention with bispecific antibodies.

How AP-Led Clinics Expand Access to Specialty Care

Models of care that involve APs, such as nurse practitioners and physician assistants, vary widely across health systems, Faiman explained. AP-led clinics face institutional, scope-of-practice, and state-level barriers.

Since 2014, Faiman has led a clinic for monoclonal gammopathy of undetermined significance, giving the team 12 years of experience increasing access for patients who need specialty care for undiagnosed conditions. Similar AP-led anemia and thrombosis clinics operate around the country, and Faiman expects the model to grow as the physician shortage continues.

"I see that the AP is well suited to diagnose, monitor, and manage these acute and chronic conditions," Faiman said. "So hopefully, this role will expand."

What Patients Should Expect With Talquetamab Taste Changes

Talquetamab, a GPRC5D×CD3 bispecific antibody, has a unique adverse effect profile because GPRC5D is expressed on keratinized cells, leading to oral, skin, and nail toxicities. Clinical research and real-world experience have shown that lowering the dose and extending the time between doses can help, Faiman said.

Faiman is involved in the TALISMAN (NCT06500884) study, which recently presented results at the International Myeloma Society meeting in Scotland on how taste changes with talquetamab. Patients lose sweet and salty tastes fairly quickly but gain brothy and umami tastes, findings that can guide food recommendations. Taste tends to improve over time, with many patients regaining it at about 3 months.

Setting expectations, recommending beneficial foods, and involving dietitians and other multidisciplinary support can help keep patients on treatment, according to Faiman, who has had patients on talquetamab for many years. "This is a very effective bispecific antibody," Faiman said.

Why Infection Prophylaxis Is Essential With Bispecifics

Across bispecific antibodies, the most important concern is increased risk of infection, Faiman said. The National Comprehensive Cancer Network guidelines for multiple myeloma were recently updated to version 1.2027, underscoring the importance of starting intravenous immunoglobulin (IVIG), antibiotics, and antiviral prophylaxis when a patient begins a bispecific antibody.

Although the guidelines say clinicians "may start" prophylaxis, Faiman said the footnotes make clear that everybody should receive it.

"If you have anybody with multiple myeloma who's receiving a bispecific antibody, then they need to be on IVIG and antibiotic prophylaxis," Faiman said. "We've learned these lessons over the last few years...but now we know how to protect our patients and keep them adhering to treatment longer."