Dr Banerjee on Selecting Between Bispecific and CAR T-Cell Treatments in Myeloma

Rahul Banerjee, MD, FACP, assistant professor, Clinical Research Division, Fred Hutchinson Cancer Center; member, the International Myeloma Working Group; assistant professor, Division of Hematology and Oncology, University of Washington, discusses potential factors that may inform treatment selection when choosing between bispecific antibodies and CAR T-cell therapies in multiple myeloma.

When deciding between bispecific antibodies and CAR T-cell therapies, there are no well-established criteria or biomarkers that provide a definitive answer, but dynamic biomarkers and disease characteristics can guide that choice, Banerjee begins. Dynamic biomarkers, such as rapidly rising abnormal ratio of kappa to lambda light chains, can indicate a high disease burden that may influence choice of therapy, he details.

For patients with rapidly proliferating disease, bispecific antibodies may be more appropriate than CAR T-cell therapies, Banerjee states. This is due to the significant time required for CAR T-cell production and administration. The process involves vein-to-vein time of approximately 1 to 2 months for the FDA-approved CAR T-cell products with the potential for longer delays with cilta-cel. The overall timeline, from initial consultation to receiving CAR T cells, can extend up to 6 months due to scheduling, collection, lab processing, and shipping.

For patients with rapidly progressing disease, the longer time required for CAR T-cell therapy might may bispecific antibodies a more feasible option, Banerjee recommends. Bispecifics generally have a quicker turnaround at approximately 2 weeks between approval and logistics setup. This faster administration can be crucial for patients with aggressive disease who cannot afford delays, he explains.

Disease burden plays a critical role in treatment decisions, Banerjee continues. Higher disease burden often correlates with increased risk of immunotherapy-related toxicities, such as cytokine release syndrome, he says. Patients with high disease burden may experience more severe toxicities due to the larger number of target cells being attacked by the therapy, Banerjee adds. However, it is also important to consider the functional status of T cells, Banerjee notes. In patients who have undergone prior chemotherapy, the T cells might be less functional, potentially leading to less effective responses or higher toxicity with CAR T-cell therapies

Currently, many centers administer bispecific antibodies on an inpatient basis, though there is a trend towards outpatient treatment in some centers, Banerjee shares. This shift can also affect patient management and treatment logistics, he concludes.