Collaborative outreach and education for management of bi-specific antibody treatment side effects in Relapsed/Refractory multiple myeloma (COMBAT-RRMM)

Abstract Introduction: Bi-specific antibodies (BsAbs) have emerged as a pivotal therapy for in relapsed or refractory disease (RRMM), offering high response rates even in refractory patients. Three such antibodies, Elranatamab, Teclistamab (targeting BCMA), and Talquetamab (targeting GPRC5D), have received FDA approval in patients who have received 4 prior lines of therapy due to their impressive response rates and progression-free survival in clinical trials. However, they introduce challenges like managing unique side effects, such as Cytokine Release Syndrome (CRS), and increased infections, necessitating comprehensive understanding and proactive management. New Mexico (NM) is one of the most rural, diverse and medically underserved states in the country. It is the 5th largest state by area with a density of 17.5 people per square mile (United States- 94 people per square mile), and ranks thirtieth among states in the number of doctors per 100,000 residents. The Health Resources and Services Administration designates all but 1 of NMs 33 counties as Medically Underserved Areas. These pose unique challenges to myeloma care especially immunotherapeutic approaches (including bi-specific antibodies) as many patients receive care at community oncology clinics due to logistical constraints.In NM, only 3 out of 15 oncology clinics (all in Albuquerque- Santa Fe Metro) have adopted these BsAbs, with hurdles like knowledge gaps in managing adverse events and unfamiliarity with these agents impeding widespread implementation.Addressing this gap is vital for enhancing patient care and outcomes, especially concerning treatments involving bi-specific antibodies.The overarching hypothesis for this study is to understand and decrease the knowledge gaps in identifying and treating the side effects of BsAbs, thereby improving the utilization of these therapies, especially in community oncology settings. Methods: We conducted workshops across 11 clinical sites in New Mexico, targeting hematologists/oncologists and oncology advanced practice providers Each session included a Pre-workshop assessment to evaluate baseline knowledge and practice followed by an Interactive workshops focused on CRS and infection management and Post-workshop assessments to measure knowledge gains. Survey data were analyzed using descriptive statistics and chi-square tests to evaluate the significance of changes in participant responses. Results: Despite about 54 registered attendees for multiple workshops, we only had 22 pre-survey responses and 18 post survey responses. Post-intervention, the proportion of participants strongly agreeing with key competencies increased substantially: familiarity with BsAbs rose from 14% to 56%, confidence in managing side effects from 9% to 61%, understanding of CRS management from 18% to 72%, and comfort in managing infections from 41% to 56%. All changes were statistically significant (p < 0.05) except for infection management. Conclusion The COMBAT-RRMM initiative significantly improved healthcare providers' familiarity and confidence in managing BsAb-related toxicities in RRMM. By addressing critical knowledge gaps and promoting institutional protocol development, the program enhances therapeutic equity and supports the safe, effective use of BsAbs in underserved regions. This model may be scalable to other rural and minority-majority populations facing similar barriers to advanced cancer care.