Bispecific antibodies have emerged as a promising treatment option for relapsed/refractory multiple myeloma, and ongoing research is now exploring their potential in earlier lines of therapy and in combination with other agents. These innovative therapies offer a unique approach to targeting cancer cells while minimizing the need for treatment at academic centers.
Dr. Joshua Richter, an expert in hematology and medical oncology, emphasized the importance of bispecific antibodies in community settings where the majority of multiple myeloma patients receive treatment. These therapies provide a much-needed option for patients who may not have access to academic centers.
One significant class of bispecific antibodies targets B-cell maturation antigen (BCMA) on myeloma cells, while engaging T cells through the CD3 receptor. Promising BCMA-targeted bispecific antibodies include drugs like teclistamab-cqvy, elranatamab-bcmm, and linvoseltamab. Additionally, non-BCMA-targeting bispecific antibodies, such as those that target GPRC5D and FcRH5, are also showing potential in clinical trials.
Dr. Richter highlighted the highly active nature of these agents and their unique toxicities, which resemble those observed with CAR T-cell therapies, such as cytokine release syndrome (CRS) and immune effector cell–associated neurotoxicity syndrome (ICANS). Proactive management, including prophylaxis for infectious complications, is crucial in ensuring patient safety.
Ongoing studies are investigating the efficacy of bispecific antibodies as monotherapy and in combination with other drugs in earlier lines of therapy. Combinations with anti-CD38 antibodies like daratumumab are being explored, along with evaluations of limited-duration treatment regimens to enhance the patient experience.
The future of bispecific antibody therapy in multiple myeloma looks promising. As these agents move from late-line to early-line treatment settings, and even frontline therapy, there is the potential for achieving deep and durable responses, possibly leading to long-term remission and even cure for some patients.
1. What are bispecific antibodies?
Bispecific antibodies are designed to simultaneously bind to two different targets, typically a specific antigen on cancer cells and a receptor on immune cells. They help facilitate the immune system’s recognition and destruction of cancer cells.
2. What is multiple myeloma?
Multiple myeloma is a type of blood cancer that affects plasma cells, which are responsible for producing antibodies. It is characterized by the production of abnormal plasma cells that accumulate in the bone marrow, impairing the production of healthy blood cells.
3. What are the toxicities associated with bispecific antibodies?
Some of the toxicities associated with bispecific antibodies include cytokine release syndrome (CRS) and immune effector cell–associated neurotoxicity syndrome (ICANS). These immune-related adverse effects can be effectively managed with appropriate monitoring and supportive care.
4. How are bispecific antibodies being studied in earlier lines of therapy?
Clinical trials are currently investigating the efficacy and safety of bispecific antibodies in patients with earlier stages of multiple myeloma. Researchers aim to determine the optimal timing and combinations of these agents to maximize their effectiveness and minimize toxicity.
5. What is the significance of using bispecific antibodies in community settings?
The majority of multiple myeloma patients receive treatment in community settings, away from specialized academic centers. Therefore, expanding access to bispecific antibody therapies in these settings is crucial to ensure that patients have access to cutting-edge treatments regardless of their location.