Evolving real-world uptake and patient characteristics of bispecific antibodies in Relapsed/Refractory multiple myeloma: Insights from a US community oncology network

Abstract BACKGROUND: The treatment landscape for relapsed/refractory multiple myeloma (rrMM) has continued to evolve rapidly with the introduction of T cell directing bispecific antibodies (BsAbs), such as teclistamab-cqyv (approved October 2022), talquetamab-tgvs, and elranatamab-bcmm (both approved August 2023) and linvoseltamab (approved July 2025). These agents are now considered preferred options for patients with rrMM after at least four prior lines of therapy. Expanding access through administering these routinely in the community setting is critical. Despite their clinical promise, real-world data on BsAb utilization and patient characteristics remain limited. Understanding the uptake, clinical and demographic profiles and outcomes of patients receiving BsAbs is critical to inform equitable access and optimize treatment strategies in community oncology settings. METHODS: This retrospective observational cohort study used data from iKnowMed, an oncology-specific electronic health record system capturing outpatient encounters across The US Oncology Network and selected non-Network practices. Adult patients with active rrMM who initiated a qualifying therapy (index event) between October 1, 2022, and July 14, 2025, were included. Patients were categorized into two cohorts: BsAb (teclistamab, talquetamab, or elranatamab) and non-BsAb (≥5 prior lines of therapy without BsAb exposure). Patient characteristics, treatments and outcomes were summarized descriptively. RESULTS: A total of 751 patients were included: 405 in the BsAb cohort and 346 in the non-BsAb cohort. Median age at index was 72 years (range 39–92) for BsAb and 74 years (range 45–96) for non-BsAb patients. Patients aged ≥70 years comprised 56.3% of the BsAb group compared to 64.7% in the non-BsAb group. Almost half of patients were female (48.1% BsAb; 46.8% non-BsAb). Among patients with documented race, 74.8% of BsAb recipients were White, 19.3% Black, and 5.9% had other races; similar distributions were observed in the non-BsAb cohort. Among those with documented ECOG, 60.4% of BsAb and 57.7% of non-BsAB patients had a score of 1, while 19.6% and 13.8%, respectively had a score of 0, indicating relatively preserved functional status. Of the 751 patients in the full cohort, 13.3% received care in the rural setting, representing 16.3% of patients in the BsAB cohort, and 9.8% of the non-BsAB cohort. Uptake of BsAbs increased markedly over time, from 4.7% of study participants initiating therapy in 2022, to 39.2% in 2023, 61.3% in 2024, and 72.9% by July 2025. Overall survival (OS) data for the BsAb cohort showed that median OS was longer in the BsAb cohort at 22.0 months (95% confidence interval [CI]: 18.9, not reached), compared to 16.0 months (95% CI: 13.1, 19.8) in the non-BsAb cohort. Twelve- and 24-month survival rates were also higher among BsAb patients (67.0% and 44.9%, respectively) than non-BsAb patients (58.9% and 37.7%). CONCLUSIONS: This study demonstrates rapid uptake and steady growth in use of BsAbs in rrMM in a community oncology setting following regulatory approvals. Patients receiving BsAbs tended to be slightly younger and with better performance status compared to those receiving other therapies, suggesting patient selection or access disparities. It is encouraging that almost one fifth of patients were receiving BsAb therapy in the potentially more challenging rural clinic setting. Our real-world data has older median age than prospective trials of BsAbs and importantly Blacks were well represented. OS in patients receiving BsAb was encouragingly in line with prospective data and with a trend to improved survival over those receiving non-BsAb treatments. Further study is needed for more complete data on measures of response, safety, reasons for treatment decisions and more mature follow-up on outcomes in this real-world setting.