Patient Selection and Line-of-Therapy Navigation: Practical Insights for a Complex Myeloma Treatment Landscape

In 'Patient Selection and Line-of-Therapy Navigation: Practical Insights for a Complex Myeloma Treatment Landscape,' our panel of experts delve into the following critical questions:

How are you defining and navigating the crowded therapy landscape in multiple myeloma?

Recent evidence describes line-of-therapy definitions as flexible in real-world practice, often supported by documentation strategies and payer appeals. How are you navigating that in your practice?

Led by the moderator, the panelists examined how clinicians are making bispecific antibody selection decisions in an increasingly crowded myeloma treatment landscape, describing a framework that considers line of therapy, CAR-T eligibility, social support, geography, and patient preference as the primary drivers, with teclistamab plus daratumumab currently representing the only bispecific combination available in the second-line setting, while agents like elranatamab and linvoseltamab are reserved for fifth line or later. The discussion also addressed the real-world complexity of defining lines of therapy accurately, with the panelists emphasizing the importance of adhering to traditional IMWG and NCCN definitions to avoid payer complications, while acknowledging that these definitions can become murkier in subsequent lines and that strict adherence to established frameworks is essential for protecting patients' access to later-line options. The panelists further highlighted a particularly challenging scenario faced by large community referral networks: patients arriving from academic centers where they have been receiving non-NCCN, non-FDA-labeled combination regimens on clinical trials, who then expect to continue their treatment commercially at the community site, noting that these situations create significant financial and payer navigation challenges that even peer-to-peer appeals cannot always resolve, underscoring the need for clearer communication between academic and community partners about what is and is not commercially transferable at the point of transition planning.

Throughout the conversation, the experts provide a comprehensive reflection on the field and the factors that may shape how clinicians approach care moving forward.

The next episode in this series, 'Availability, Patient Preference, and Linvoseltamab: What Pharmacists Need to Know About the Evolving Bispecific Landscape,' features the panelists advancing their conversation on multiple myeloma and focusing on how the off-the-shelf availability of bispecific antibodies factors into clinical decision-making relative to CAR-T, how patient preference shapes the choice between these two modalities, and what pharmacists need to understand about linvoseltamab's distinct operational profile compared to other bispecific agents already in use.