ASH 2024 | Does the relative dose intensity of bispecific antibodies matter in patients with multiple myeloma?

Multiple myeloma patients that receive bispecific antibodies are patients that unfortunately have been very heavily treated in the past and are looking for options that provide an advantage in survival and quality of life. Sometimes what we have seen in daily practice is that some patients tend not to be fully compliant with the schedule proposed by the prescribing information. But still, we see that some of them have a persistent response over time. The mechanism of action of those antibodies that bring both the immune cell and the tumor cell together seems to be the cause. And one of the questions that was triggering us to do this research was, what happened with the dose? What happened with the dose? Does relative intensity dose modeling in this case mean we should be fully compliant, or can we have sort of vacation-like use of the treatment? So we decided to explore that. We had a case series of patients treated at the Weill Cornell Medical Center. What we did is that we identified variables related to treatment before the bispecific, how was the bispecific, and how was the efficacy and safety after that, including how the doses were given. The relative dose intensity was defined for this study as the dose in milligrams expected to be received for each patient, including the step-up dosing and the timing expected by the prescribing information. There was not a specific timeline for each patient. We took 100% as the last day of the patient receiving the dose. We measured for expansion the relative dose intensity, expecting 100% compliant based on timing and dosing. So for that, we ran the statistics, univariate, multivariate analysis, trying to find out if it matters, and we found that it matters. But surprisingly, patients that have excellent compliance did poorly in progression-free survival. Why is that? We analyzed what happened with those patients and we really identified that the relative dose intensity, the good compliance is driven mainly by patients that are good or bad responders. You know that all patients at the beginning of treatment, if you didn’t have more options, were very compliant, right? So we saw that. At the beginning, they were very, very compliant, and the patients that did not respond well stopped the treatment, but they were already compliant, so the relative intensity dose was more than 95%, but those that were not compliant had a sorry, those that had better responses were less compliant over time, they started having vacation periods, you know, patients have lives. Sometimes I remember a case that she wanted to see the graduation of her daughter, so she wanted to skip a dose. And those situations happened daily. So we saw that. We saw that, going back to the study, we saw that patients with high relative dose intensity are driven by poor response. But once we ran the analysis, only patients that responded over time, we noticed two things. The first is that the median relative dose intensity is not 95% but 85%, it drops. And the second thing that we found is that it really doesn’t matter. So patients that have either over 50%, over 85%, or under 85% of relative dose intensity seem to be the same. So this is the main conclusion. So about if it really matters or not, it’s something that needs to be explored. If patients can stop treatment and evaluate, it’s something that needs to be explored. But it brings hope for the patients in the long term to potentially explore the possibility to reduce either the frequency or the amount of dosing and still obtaining the survival of achieving response, progression-free survival, and overall survival, and possibly improving the quality of life. That is something that should be explored in the future. Our study seems to prove that this could be feasible to do, and that’s something that can be done in the upcoming months.

This transcript is AI-generated. While we strive for accuracy, please verify this copy with the video.