Bispecific Antibodies, Breast Cancer, and Myeloma: Top OPC Takeaways

In this interview with Pharmacy Times at Oncology Pharmacists Connect in Austin, TX, Megan May, PharmD, BCOP, FHOPA, FAPO, ambulatory oncology clinical pharmacy specialist, Baptist Health Systems, discusses key clinical updates presented during conference sessions highlighting data from the 2026 ASCO Annual Meeting and the 2026 European Hematology Association Congress. May reviews practical considerations surrounding bispecific T-cell engagers, including differences in toxicity monitoring, administration, and implementation across practice settings. She also highlights emerging breast cancer data supporting continued use of first-line CDK4/6 inhibitors following localized progression and discusses evidence supporting extended-interval denosumab dosing.

Pharmacy Times: You attended the bispecific antibody session at OPC. What were some of the key takeaways, and why are these important for oncology pharmacists?

Megan May, PharmD, BCOP, FHOPA, FAPO: The first session I attended at OPC focused on the differences among bispecific T-cell engagers. The presenters compared the various agents, including differences in formulation, dosing schedules, and recommendations for monitoring cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) associated with each therapy.

They also discussed the differences between bispecific T-cell engagers and other bispecific antibodies that do not engage T cells. I think it is important for oncology pharmacists to understand these distinctions and know how to apply them in clinical practice.

From a practical standpoint, this information is valuable when making formulary decisions, such as determining which agents should be reviewed through the Pharmacy and Therapeutics (P&T) committee process. It is also important for developing staff education programs and ensuring that clinicians understand the differences among these agents, including their toxicity profiles, monitoring requirements, and observation periods. Being able to distinguish between the various therapies is essential for implementing them safely and effectively in practice.

Pharmacy Times: What breast cancer updates discussed at OPC stood out to you, and how might they impact clinical practice?

May: At OPC, when we discussed the breast cancer abstracts presented at ASCO, the panel did a great job not only sharing the data but also explaining how to apply the findings in real-world clinical practice.

Two abstracts, in particular, stood out to me. The first examined whether patients can continue first-line CDK4/6 inhibitor therapy after experiencing local progression, such as progression limited to bone. In these situations, patients may receive local treatment for the progressing lesion, but the question is whether they should continue the same CDK4/6 inhibitor or switch to another therapy. The abstract discussed by the panel suggested that patients may be able to continue the same CDK4/6 inhibitor without moving to another line of therapy. If I recall correctly, the study showed approximately 10 additional months of progression-free survival with continuation of the first-line CDK4/6 inhibitor. That is something I plan to take back to my practice, as it may help preserve later lines of therapy for patients who need them.

The second abstract that stood out evaluated the use of denosumab every 12 weeks compared with every 4 weeks. In my own practice, I have already been using denosumab every 12 weeks, particularly in patients with prostate cancer, but also in those with breast cancer. The ASCO abstract included both patient populations and compared standard dosing every 4 weeks with a strategy of every 4 weeks for the first 4 cycles followed by dosing every 12 weeks thereafter. The study demonstrated similar outcomes between the approaches.

When considering financial toxicity, the every-12-week schedule is clearly advantageous compared with every-4-week dosing. It is also more convenient for patients because they do not need to come into the clinic as frequently to receive their bone-modifying agent. Based on these findings, I think this is a good practice, and we will continue using this approach locally. It is also reassuring to have data from ASCO supporting that what we have already been doing is appropriate for these patient populations.

Pharmacy Times: How can pharmacists apply broader oncology research that is not specific to a single disease state in their daily practice?

May: One of the things I really appreciate about ASCO is that even some of the more generalized abstracts can have meaningful clinical implications. For example, studies examining whether frailer patients should receive active treatment or whether a palliative care-focused approach may be more appropriate can provide valuable insights for clinical decision-making.

We also continue to see abstracts across a variety of disease states that focus on biomarkers and treatment selection. These studies are highly valuable in real-world practice because they help inform how we choose therapies for individual patients.

In addition, patient-reported outcomes are particularly important. As a pharmacist, I often meet with patients before they begin treatment to provide education about their therapy. Having access to real-world patient-reported experiences helps me better explain what patients may expect while receiving treatment and how a therapy may affect their quality of life. Ultimately, these data help me provide more meaningful counseling and better prepare patients for their treatment journey.

Pharmacy Times: What were some of the key multiple myeloma updates discussed during the OPC session?

May: In the multiple myeloma session at OPC, the presenters discussed several abstracts that were presented at EHA and ASCO. One of the studies that stood out to me was the MajesTEC-9 trial, which evaluated the use of teclistamab in patients who had previously received a CD38 monoclonal antibody.

Prior to ASCO, much of the focus had been on the combination of teclistamab and daratumumab in the second-line setting. However, the data discussed at OPC raised the possibility that teclistamab monotherapy may also be an effective option. One aspect of the session that I particularly appreciated was the panel discussion, which included pharmacists from academic practice, community practice, and managed care. Hearing perspectives from all 3 settings provided valuable insight into how these data may be interpreted and applied in practice. For example, it was interesting to hear from a pharmacist working on the payer side about how they would evaluate teclistamab plus daratumumab compared with teclistamab monotherapy.

The panel also discussed the operationalization of these therapies. As bispecific T-cell engagers continue to move into the community setting, ensuring access and implementation becomes increasingly important. If studies such as MajesTEC-9 support the use of teclistamab monotherapy in the second-line setting, a larger number of patients may become eligible for treatment. As a result, it will be important for more institutions to develop the infrastructure necessary to provide these therapies safely and effectively.

Another key topic was the sequencing of CAR T-cell therapy and bispecific T-cell engagers. Data presented at ASCO suggested that administering CAR T-cell therapy before bispecific T-cell engagers may result in better outcomes. The discussion included improved 5-year overall survival outcomes and the observation that outcomes remained favorable even when a BCMA-targeted bispecific was administered after BCMA-directed CAR T-cell therapy.

What I found particularly valuable was the panel's discussion of how these findings translate into real-world practice. We are increasingly seeing combination regimens that incorporate bispecific T-cell engagers, which raises additional questions about sequencing. Will these therapies still be used primarily after CAR T-cell therapy, or could they move earlier in the treatment paradigm? Additional data are needed to answer these questions, but it is clear that this area will continue to evolve rapidly over the next several years.