Tailoring CAR T, Bispecific Use in Myeloma: Amandeep Godara, MBBS

Individualizing therapy selection between chimeric antigen receptor (CAR) T-cell treatment and bispecific antibodies has become increasingly feasible for patients with multiple myeloma as clinicians gain more hands-on experience with both approaches, Amandeep Godara, MBBS, said in the third and final part of an interview at last week's Institute for Value-Based Medicine® event in Salt Lake City, Utah.

Rather than following a fixed algorithm, Godara said his team at Huntsman Cancer Institute now relies on a deeper understanding of each patient and their disease to guide the choice of next therapy. He added that he prefers to discuss bispecific antibodies with older patients or those with significant comorbidities or other health issues that may affect their ability to tolerate CAR T-cell therapy or its associated toxicities.

In addition, Godara noted that toxicity management for bispecific antibodies has evolved. While early use of these therapies was associated with high rates of cytokine release syndrome, dose ramp-up protocols and prophylactic use of tocilizumab have enabled more effective toxicity mitigation.

These safety conversations are now part of patient counseling before starting a bispecific antibody, along with a clear plan for monitoring and prophylaxis once patients return home. At Huntsman Cancer Institute, Godara highlighted that the goal is to ensure this same monitoring standard and prophylaxis regimen extends to patients who live farther away, such as in Idaho or Montana, so that the outcomes seen at the treating institution can be replicated regardless of where an individual lives.

Looking ahead, he emphasized that closer collaboration between academic centers and community oncology practices will become increasingly necessary as more immunotherapy options become available to patients with multiple myeloma. Access to these therapies, he added, needs to be universal and widespread, which can be achieved through stronger ties between academic and community sites.

Godara also said an academic center's responsibility extends beyond delivering treatment and transferring a patient's care back to their community oncologist. It also includes helping community physicians recognize when to consider these therapies in the first place, as well as how to weigh CAR T-cell therapy against a bispecific antibody or a cereblon E3 ligase modulatory drug combination; these multidisciplinary decisions require ongoing collaboration and consideration.

"One other thing that we could all do better is educating not just our community colleagues but also our own patients about what other options are available for their myeloma so that patients [who] come to us can ask us for these therapies whenever they are not informed about these treatments beforehand," Godara concluded.