Dr Banerjee on Future Hopes For Bispecific Antibody Therapy 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 his hopes for the future of bispecific antibody therapy for patients with multiple myeloma.

Banerjee states that if he could make one wish for bispecific antibodies, it would be to make them available at every treatment center in the United States (US) and worldwide. The greatest innovation in myeloma management won’t be solely about improving efficacy but also about managing cytokine release syndrome (CRS) more effectively, he imparts. Even in the US, patients often need to travel long distances to receive treatment with bispecific antibodies, because many centers lack the necessary expertise and infrastructure to administer these agents, he explains. The multidisciplinary team required for administering bispecific antibodies includes physicians, nurses, pharmacists, and logistical support to handle the complex initial dosing protocols like step-up dosing, according to Banerjee.

Innovations to prevent CRS are promising, Banerjee reports. Currently, tocilizumab (Actemra) is used to manage CRS, but preventive use of this agent could reduce the severity of CRS, even if it still occurs, he says. In fact, studies from the CAR T-cell therapy world are being adapted for bispecific antibodies and are demonstrating the potential of tocilizumab as a preventive measure, he explains. However, the challenge is that tocilizumab is an intravenous treatment, is costly, and has traditionally required hospitalization for CRS management, making it difficult for smaller centers to adopt bispecific antibody administration, Banerjee says. The hope is that, with improved CRS management, bispecific antibody initiation could become safer and more widely accessible, much like how rituximab (Rituxan), once a hospital-based treatment, is now available in most community clinics across the US, he emphasizes.

In terms of future scientific innovations, combination regimens containing bispecific antibodies are intriguing, Banerjee continues. For example, the phase 1b RedirecTT-1 trial (NCT04586426), which evaluated the combination of teclistamab-cqyv (Tecvayli) and talquetamab-tgvs (Talvey), agents that target different proteins, showed promising responses in patients with relapsed/refractory multiple myeloma, even in those with aggressive disease, such as extramedullary myeloma. This dual-target approach may eventually rival the efficacy of CAR-T therapy, potentially transforming the treatment paradigm for these high-risk patients, he concludes.