Dr Banerjee on Deciding Between CAR T-Cell Therapy and Bispecific Antibodies in Myeloma

Rahul Banerjee, MD, FACP, assistant professor, Clinical Research Division, Fred Hutch Cancer Center; member, the International Myeloma Working Group; assistant professor, Division of Hematology and Oncology, University of Washington, discusses criteria utilized in deciding between treatment with bispecific antibodies and CAR T-cell therapy for patients with multiple myeloma.

Unfortunately, there isn’t a definitive answer to this question, but dynamic biomarkers, rather than static one-point biomarkers, can provide helpful guidance, Banerjee begins, adding that traditional tests already used in clinical practice can assist in identifying the best treatment candidates. For instance, patients with rapidly proliferating disease, in whom the levels of biomarkers are quickly rising, may not be ideal candidates for the autologous CAR T-cell therapies currently approved by the FDA for patients with multiple myeloma. The time from leukapheresis to the administration of CAR T cells, known as the “vein-to-vein” time, is typically 1 to 2 months for both idecabtagene vicleucel (Abecma) and ciltacabtagene autoleucel (Carvykti; cilta-cel), although it can be slightly longer for cilta-cel, he explains.

In addition to “vein-to-vein” time, another factor to consider is “brain-to-vein” time, which refers to the time it takes for a patient to receive CAR T-cell therapy after their hematologist has determined it is needed, Banerjee continues. This process can take approximately 6 months, as it involves finding appointment availability at a CAR T-cell center, followed by T-cell collection, shipment to the lab, processing, testing, and finally bringing the patient back to the center for therapy, he states.

Before the availability of bispecific antibodies, efforts to increase patient access to CAR T-cell therapy often involved the use of high-dose chemotherapy, which was associated with significant complications, Banerjee continues. For patients with rapidly progressing disease, bispecific antibodies are a much more practical option, as the “brain-to-vein” time is significantly shorter—approximately 2 weeks, including time for insurance approval and logistical arrangements, according to Banerjee. This faster turnaround time makes bispecific antibodies a preferable option in cases of aggressive disease progression, he concludes.