The TACTUM23 Study: Access to Cellular Therapies in Multiple Myeloma: Perspectives of Treating Versus Referring Physicians in 2023

Introduction Despite promising efficacy and safety profiles of BCMA-directed cellular therapies (BDCT) for multiple myeloma (MM), limited access is a challenge. This survey gains insights into the practices and perspectives of oncologists from BDCT-referring and treating centers and identify potential areas of improvement. Methods The survey was developed in collaboration with USMIRC with input from BDCT-prescribing and referring oncologists. “ BDCT centers” included CART and TCE-Centers where these respective therapies were administered, while others were grouped as “BDCT-referring centers” including “CART/ TCE- referring centers”. Interim Analysis is described. Results The survey was sent to 247 oncologists of which 66 (27%) responded and 37(15%) completed. 73% of oncologists were from academic centers, and 54% treated plasma cell disorders only. 70% were from CART-centers and 81% were from TCE- centers. 11% of centers offered only TCE while none exclusively offered CART alone. Among CART-centers, 54% offered both ide-cel/cilta-cel. Oncologists practiced in the Midwest (43%), South (22%), West (19%), and Northeast (16%).Choice of BDCT in Real-World Scenarios: TCE was the favored BDCT for patients meeting criteria but with either significant comorbidity, renal failure, poor performance status, mild cognitive impairment, age >75yr, rapidly progressive disease, or post-CART relapse. CART was preferred for scenarios of extramedullary disease, allogeneic stem cell transplant recipients, and renal failure on dialysis.Respondents ranked choices of potential barriers to access as below (Figure 1)Barriers to CART access: Financial burden was the top-ranking barrier (45%) from CART-referring centers, while the number of production slots allocated per month was the top barrier (69%) from CART-centers. Relocation and caregiver requirements were ranked as top barriers by 27% from CART- referring centers and none from CART-centers.Barriers to TCE access: Among oncologists from TCE-referring centers, the majority (43%) felt that financial burden was the top barrier to access for TCE while 63% of oncologists from TCE-centers identified hospitalization requirements as the top barrier.Infrastructure Availability for side effect management in referring centers (Figure 2) Conclusions While limited by low number of responses, this survey is the first to delineate barriers to BDCT access by treating versus referring centers in MM. Primary concerns are financial burden, relocation requirements for CART, and hospitalization for TCE. Most oncologists at BDCT-referring centers are able to identify and manage low-grade CRS and ICANS. Future steps to increase collaboration between treating and referring centers include outpatient BDCT programs and clearer guidelines for transferring patients after the initial month of BDCT therapy.