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ACCCBuzz spoke to Joshua Brody, MD to better understand how Bispecific Antibodies work and how they can be easily implemented in the community setting.
This is the second in a series of 3 blog posts highlighting the Association of Cancer Care Centers (ACCC) education program focused on Successful Integration of Bispecific Antibodies into Community Oncology Practice. You can read the first one here.
For cancer programs and practices cautious about implementing bispecific antibody (BsAb) therapies, ACCCBuzz spoke to Joshua Brody, MD, director of the Lymphoma Immunotherapy Program at The Tisch Cancer Institute at Mount Sinai and a faculty member of the Icahn Genomics Institute, to better understand how BsAbs work and how they can be easily implemented in the community setting.
Dr. Brody describes the concept of BsAbs as “elegant and simple.” Bispecific antibodies “tell your immune system which cells to target and kill. With immunotherapies, like anti-PD-1 antibodies, your immune system figures it out on its own—creating a nebulous uncertainty.”
Since BsAbs are a newer form of treatment, some common myths and misconceptions remain, such as general fear of unknown side effects and a misconception that BsAbs require the same level of infrastructure and adverse event management as chimeric antigen receptor (CAR) T-cell therapy.
“One of the most common side effects we talk about is cytokine release syndrome (CRS). For CAR T-cell therapy, CRS [incidence] can be high double digits, but for bispecifics, the high-grade version of CRS is not just single digits, but 1% to 3% at the highest. So, they are just much safer and therefore easier to monitor after use.”
To address these concerns, Dr Brody highlights that community oncologists need to know that BsAbs:
“We have treated many 80 to 90-year-olds with bispecific antibodies. I'm not saying that they have no risk. They do, every medicine we have has potential side effects and risks. But overall, we think they have been both safer and much more effective than most of the other options for these patients.”
Connecting with an oncologist experienced in BsAb administration is Dr Brody’s top tip for community oncologists who want to start offering this treatment option to their patients.
“It’s best to do it with an experienced person on speed dial. It could look like the patient seeing both of us, or simply reaching out with a call or text. My phone is full of texts from my oncology buddies across the New York tri-state area and beyond who are doing this for the first time. Talking with your academic buddy who’s been administering bispecific antibodies for the past four years can give you the nuances that a PubMed article or brochure won’t be able to provide. We’ve dealt with the infrastructure issues – nothing complicated, but little practical things we had to do. We are very motivated to build these relationships with community oncologists, so reach out to us.”
Dr. Brody knows that any new medication can be scary and anxiety provoking, recalling how everyone was nervous 20+ years ago when it came to managing infusion reactions to rituximab, but now there is no anxiety about administering it today. Brody is confident that over the next few years everyone will become comfortable treating patients with bispecific antibodies and now is the time to learn.
“Bispecific antibodies will be standard frontline therapy for lymphoma in the next few years and it's not going to be optional. So, you might as well address it now and get your patients access to the future today.”
Offering BsAb therapies in the community setting can be beneficial to patients who would have trouble accessing other treatment options due to their age, ability to travel to an academic or tertiary care center, ability to take time off work, and level of social support. Dr Brody notes, “Bringing effective care closer to home helps narrow that health equity gap.”
Additional resources for cancer care teams can be found in the ACCC Bispecific Antibodies resource library.
The ACCC Successful Integration of Bispecific Antibodies into Community Practice education program is supported by Genentech and Johnson & Johnson.