The Bispecific Antibody Evolution and the CAR-T Access Imperative

In 'The Bispecific Antibody Evolution and the CAR-T Access Imperative,' our panel of experts delve into the following critical questions:

1. MagnetisMM-16 captures elranatamab use in a heavily pretreated population, over 60% had received 4 or more prior lines, and nearly 85% were triple-class exposed. As bispecific antibodies like elranatamab move earlier in the treatment algorithm, how do you anticipate the real-world patient profile for these agents will shift, and does earlier use change how you think about their risk-benefit profile?
2. CAR-T cell therapy carries a second-line indication in multiple myeloma, yet uptake remains variable, particularly outside of academic centers. How are you incorporating CAR-T into your second-line decision-making, and what barriers most commonly prevent patients from accessing/offering it?
3. On the flip side, what advancements have happened in recent years to expand access and improve operational procedures for CAR-T therapy? Are there models of success you can highlight that are demonstrative of what is possible?

Led by the moderator, the panelists examined how the real-world patient profile for bispecific antibodies is shifting as agents like elranatamab move into earlier lines of therapy, noting that while MagnetisMM-16 captured a heavily pretreated, triple-class-exposed population, the growing accessibility of bispecifics in community settings is enabling their use in less refractory patients, raising important questions about how earlier deployment changes the risk-benefit calculus and whether it will ultimately challenge CAR-T's position as the preferred second-line option for eligible patients. The discussion also addressed the persistent barriers limiting CAR-T access outside of academic centers, with the panelists identifying caregiver availability, geographic distance from treatment centers, and the financial and logistical burden on working patients and families as the most significant obstacles, and emphasizing that bridging these gaps requires intentional outreach to community oncology practices and creative solutions to support patients through the process. The panelists further highlighted the meaningful operational advancements that have expanded CAR-T access in recent years, including manufacturer patient support programs that cover travel, lodging, and food expenses, the rollback of the 30-day REMS-mandated stay requirement that now allows stable patients to return home as early as day 14 or 15, the growth of outpatient CAR-T administration models, and the increasing role of remote monitoring technology and institutional collaboration between academic and community centers in making CAR-T a more accessible and sustainable treatment option for a broader patient population.

Throughout the conversation, the experts provide a comprehensive reflection on the field and the factors that may shape how clinicians approach care moving forward.

The next episode in this series, 'Beyond Clinical Efficacy: How Cost, Access, and Operational Challenges Influence RRMM Treatment Decisions,' features the panelists advancing their conversation on multiple myeloma and focusing on how cost and access considerations factor into treatment selection at first relapse, whether patients are being steered toward certain therapies for non-clinical reasons, and the most significant logistical challenges associated with bispecific antibody therapy from a pharmacy and operational standpoint.