Leading experts from the University of Arkansas Medical Sciences (UAMS) and CARTI Cancer Center highlight the critical importance of collaboration between academic and community cancer centers in optimizing multiple myeloma treatment outcomes.
The Value of Integrated Care
"The outcomes are better when there is integrated care between academic centers and the community," emphasizes Dr. Frits van Rhee, professor of medicine and clinical director of UAMS Myeloma Center. He explains that while academic centers are better equipped to deliver complex and intensive therapies, ongoing care must be maintained locally through community oncologists.
The collaboration involves multiple layers of support, including nursing teams, nurse practitioners, transplant coordinators, and social workers. This comprehensive approach ensures patients receive optimal care regardless of their location.
Streamlining the Referral Process
Dr. Appalanaidu Sasapu, a hematologic oncologist at CARTI Cancer Center, describes the importance of having a well-defined referral system: "There should be streamlined communication which is predefined and works for everybody. There should be an intake coordinator at the academic center, and that person will be the single point of contact for all communications."
The process includes careful documentation, regular follow-up, and constant communication with patients to maintain trust and ensure smooth transitions between care settings.
Managing Novel Therapies
The landscape of multiple myeloma treatment has evolved with the approval of three bispecific antibodies - two targeting BCMA (elranatamab and teclistamab) and one targeting GPRC5D (talquetamab). These treatments require specialized expertise and careful management of potential side effects.
"These bispecifics and CAR T-cell therapies have unique toxicities, which we don't see with standard of care therapies," notes Dr. Sasapu. These include cytokine release syndrome (CRS) and neurotoxicity, necessitating specialized training and certification through the REMS program.
Treatment Sequencing and Patient Selection
Dr. van Rhee provides insight into treatment sequencing: "If a patient is eligible, the sequence of first doing CAR T cells and then bispecifics is probably the best one." This approach helps prevent potential resistance mechanisms that could develop through prolonged antibody exposure.
Patient factors such as age, fitness level, and geographical location play crucial roles in treatment decisions. The experts emphasize that while treatment principles remain consistent, implementation must be tailored to individual patient circumstances and local healthcare resources.
Managing Side Effects and Long-term Care
The management of treatment-related complications requires ongoing vigilance. Particular attention must be paid to infection risk, as these therapies can affect normal plasma cells and immune function. Preventive measures include:
- Prophylactic antibiotics
- Intravenous immunoglobulin (IVIG) administration
- Regular monitoring for viral infections
- Careful dose scheduling to prevent immune cell exhaustion
Future Directions
The field continues to evolve, with novel therapies moving into earlier treatment lines. Clinical trials are exploring fixed-duration treatments and new approaches to therapy sequencing, potentially transforming the standard of care for multiple myeloma patients.
"We are going to see a paradigm shift where some of the older treatments in the future may be replaced by these novel immunotherapies," predicts Dr. van Rhee, highlighting the dynamic nature of multiple myeloma treatment and the ongoing need for academic-community collaboration.
