Current and Future Considerations in the Treatment of Relapsed/Refractory Multiple Myeloma - Episode 9

RRMM: Educating Pharmacists on Anti-BCMA Therapy

March 26, 2021

The importance of coordinated care and proper education to pharmacists on best practices when dispensing anti-BMCA therapy to patients with relapsed/refractory multiple myeloma.

Bhavesh Shah, RPh, BCOP: There are extensive REMS [risk evaluation and mitigation strategy] programs that we are exposed to with other myeloma drugs. This is nothing compared to that. But I think the thing that throws off people is the outside expertise that you need. You can’t have a hematologist assessing for keratopathy or visual acuity, even though they could probably do it. What I hear is that pharmacy is probably heavily involved in caring for these patients because somebody needs to make sure that the patient gets to the appointment, the patient has that test before their dose.

That’s part of the REMS and there’s an authorization that you get. But it’s not like the other REMS programs where you actually need an authorization number, and then you get a confirmation number, and then you dose the patient. There are definitely steps that need to happen, and I know that pharmacy has been leading, at my institution, in oversight of this. I want to know how pharmacy is involved at your institutions.

Ryan Haumschild, PharmD, MS, MBA: Bhavesh, I know I already spoke, but one of the things I want to bring up that’s been key is, I’ve had a lot of people across the country reach out to figure out how to operationalize this. We’re very collaborative, oncology pharmacy is a small world, and so we’re always here to help each other, and especially with something like belantamab, which is new and innovative. One of the key pieces I want to share is, we’re so used to managing REMS sometimes in the multiple myeloma clinical only. We keep Revlimid in the clinic, not a lot of specialty pharmacies have access to the IMiDs [immunomodulatory drugs], so we’re used to sending it outside.

It’s kind of its own world. And what we’re finding is if people try to keep that model with Blenrep and only have someone in the clinic management, it’s not going to be sustainable. You’ve got to collaborate with your infusion center, whether you’re Robert and working with a community infusion center, or a different infusion center, or whether within an integrated delivery network. It’s so important to both have people own it, and put some onus on pharmacy like you mentioned, because that’s the way it is going to be most successful. I’ve seen people run into so many road blocks when someone in clinic is trying to manage the whole thing; it’s not always feasible.

But when you have a key player like Robert or like my multiple myeloma pharmacist, and then you have an authorized representative [AR] in the infusion center who’s also a key partner to make sure things are getting signed off in time, that’s where it becomes almost seamless at that point. Especially with where BCMA therapy is headed, it’s not something that’s going away, and so it’s important that we figure this out now so patients can get started. I didn’t mean to circle back to our process, but I’ve learned from a lot of community practices and hospitals that these are some of the tripping blocks that hold them back from being able to treat more patients.

Bhavesh Shah, RPh, BCOP: Go ahead, Robert.

Robert Mancini, PharmD, BCOP, FHOPA: I agree with what Ryan said on that one, and I have also done the same thing, helped others in our area who are trying to get this set up. What I find is that when there’s reluctance for any one person to take the reins as well, you run into the same issues that Ryan talked about. For us at least, I am the AR, yes in the clinic, but our clinic is not the only one that uses the drug. So we’ve set up every one of our infusion center pharmacists not as ARs, but as delegates for the health care system, and that’s helped ensure we have someone else who is managing that piece.

At least for us, one of our benefits of being on Epic [electronic record program], we’re able to build a lot of these safeguards and these processes into the treatment plan itself to make sure that everyone knows about it, and we provide that education. But for us, the biggest coordination is not just in pharmacy, but between myself or the other pharmacist and our primary nursing staff. Each of our oncologists has a primary nurse who works with them, and it’s coordination between the two of us to ensure that those steps and the coordination, especially with the other providers, happen.

Bhavesh Shah, RPh, BCOP: I think anti-BCMA therapies are going to be part of the treatment of myeloma. We have combinations coming out, so I think it’s really important to have this figured out right now, versus trying to figure this out later when you have combinations involved. It’s great to share best practices and continue to utilize other resources from institutions that have done this with success.

Transcript edited for clarity.