VIDEO: Co-managing patients with multiple myeloma for best outcomes

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Yeah, collaborative care becomes more and more important. It's always been important, but now once the landscape is changing so rapidly and when we have so many options in our repertoire, I think collaboration between community oncologists and tertiary centers has plans to happen early and continues throughout patient journey. So, as I already mentioned, novel bispecific T-cell engagers are a practice changing class of drugs currently in later relapse multiple myeloma. And due to early toxicity and logistical challenges, those drugs are much easier to safely initiate at the tertiary center. But the window for all these side effects that require very close monitoring and resources is quite narrow. And so, after the first cycle — or even the first cycle — patients can safely be transitioned back to the community and receive those treatments as a long-term maintenance close to home. And there are additional things that need to be monitored, such as infectious risk, and all this can safely be done in the community. But having continuous collaboration with the tertiary center oncologist is very helpful and beneficial.

Of course, we have CAR-T as a late line of therapy and soon to be in early line of therapies that requires very close collaboration between community oncology and tertiary centers. Also, referrals. I really appreciate early referrals, let's say for CAR-T evaluation because there's also logistics involved in getting patients through the apheresis, getting insurance approval and getting patients through a pretty long time for CAR-T manufacturing — we really should start thinking about it early. And the earlier we can get the patient plugged in, the easier,the course/more smoother the course will likely be. Also, we can now offer options to those patients, right? We can offer two different CAR-T products and three different bispecific. So, when the patient is referred to me now as the discussion is much more complex and there are so many factors that will influence our treatment decision and it would involve patient's preference in terms of the toxicities, patient's resources in terms of social support, geographic preference. So, if we get these patients early on, we can actually have this discussion and come up with the best long-term plan.

Now clearly patients who a little bit ago were not even referred because they were deemed not CAR-T candidates because of age or frailty then actually now be considered again for bispecific antibodies or even this appropriate support for CAR-T. So, co-management collaboration is very important. If you talk about a newly diagnosed or early relapse myeloma as a collaboration is also important because even for induction therapy, we can now rationally choose between several treatment options — more intense or less intense. We can potentially do more comprehensive cytogenetic testing in the referral centers and that can influence our decisions. And there are exciting front-line trials. So, I think myeloma patients really need to be co-managed to have the best outcomes long term.