COMy 2026 | Expanding access to bispecific antibodies and CAR T-cell therapy in myeloma

So, T-cell immunotherapies have completely changed the way that we’re treating multiple myeloma and in fact the survival has changed substantially as a result and patients’ quality of life has also improved. And that’s great, but we need to ensure that patients across the country are receiving this drug. Currently in the UK we have access to BCMA bispecific antibodies and GPRC5D bispecific antibodies, so teclistamab, talquetamab and elranatamab, and they’re approved as per the license at fourth line triple-class exposed patients. Because these drugs are slightly different, you need to be cautious with cytokine release syndrome, the potential of ICANS and severe infections. And patients normally need to be either hospitalised or be near a hospital site for the first two step-up doses and the main maintenance dose. And that varies from each particular product. Now, typically, these are given in the larger academic centres who have the capacity to be able to be able to do this. But that leads to problems because patients need to travel long distances to come to academic hospitals. And so it’s incredibly important that these drugs are taken up by smaller hospitals so that patients can get access. And we’re certainly seeing across the UK there isn’t enough access to bispecific antibodies outside of the major centres. So in order to improve that, we already have written a pathway document called EMBRACE, which allows our protocols to be used by any hospital in the country, and we encourage hospitals to use our protocols. That’s the first thing. The second thing is to reassure them that CRS is quite mild and can be managed with tocilizumab very easily. In fact, the use of prophylactic tocilizumab substantially reduces the risk of CRS and particularly grade 2 CRS is very very low with that. And then the third thing is to try and improve and increase the number of patients who are having step-up dosing as an outpatient. And that can be easily done as long as you monitor the patients very closely and have a pathway in place. So in my hospital, we allow that and we give patients dexamethasone so that if they have a fever, so grade one CRS, they take their dexamethasone and they contact us and they come up for assessment. And so in that way, you can minimise the number of patients who are being brought into hospital. And the better way, in fact, to reduce the number of hospital admissions is to give prophylactic tocilizumab because if you do that, then the vast majority of patients can be treated as an outpatient, the CRS rates are low, and this would be a very effective place in district general hospitals. CAR T-cell therapy, on the other hand, is very restricted in the UK due to reimbursement limitations, but we’re hoping that we may have access next year. But clearly, if we do have access then we’re going to need to make sure that patients are referred to CAR-T approved hospitals to be able to at least have a discussion as to whether CAR T-cell therapy is appropriate for them. So I’d really encourage clinicians to be referring patients into CAR-T centres. There are already a number of clinical trials that are running at the major centres and if and when we get access then we need to be making sure that patients are referred very early on so that conversations can happen before the disease becomes too active.

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