Dr Edwin on Bringing Bispecifics Closer to Home

In this episode of Community Corner, Natasha Edwin, MD, of Providence Portland Medical Center and Providence St. Vincent Medical Center, discusses practical strategies for bringing bispecific antibody therapies closer to home for patients with cancer. As these therapies move earlier in treatment algorithms, Edwin highlights approaches community oncologists can use to manage treatment initiation, toxicity, and supportive care.

Edwin discusses the growing use of prophylactic tocilizumab (Actemra) to help mitigate cytokine release syndrome (CRS), as well as the practice of referring patients to larger centers for initial step-up dosing before returning them to their community oncology teams for ongoing treatment. She emphasizes, however, that managing bispecific therapy extends beyond the initial doses and requires comprehensive supportive care, including proactive infection prevention and intravenous immunoglobulin (IVIG) replacement.

She also explores toxicities associated with BCMA-directed bispecific therapies, including skin, hair, and nail toxicities, dysgeusia, anorexia, and weight loss. Edwin stresses the importance of anticipating these adverse effects rather than waiting for them to develop, including early nutritional support and skin care.

“An ounce of prevention is worth a pound of cure,” she noted.

Finally, Edwin discusses how community oncologists can counsel patients about bispecifics and other novel therapies. She emphasizes presenting patients with their full range of options while discussing not only efficacy, but also the logistical and caregiver demands associated with each treatment. Understanding what is feasible for patients and their families, she notes, should be part of treatment conversations from the beginning.