Dr Fisher on the Integration of Bispecific Antibodies and CAR T-cell Therapy into CRS Treatment

David C. Fisher, MD, institute physician, Medical Oncology, Dana-Farber Cancer Institute; assistant professor of medicine, Harvard Medical School, discusses the integration of treatment with both CAR T-cell therapy and bispecific antibodies into the therapeutic landscape for patients with cytokine release syndrome (CRS).

CAR T-cell therapy can be associated with unique challenges, particularly in the management of CRS, Fisher begins, noting that it requires specialized care, including the rarer use of IL-6 inhibitors such as tocilizumab (Actemra). He emphasizes that many centers may not have extensive experience in managing these adverse effects, which can make the transition to adopting CAR T-cell therapy more complex. Having required personnel with experience in managing these protocols is essential for successful integration into clinical practice, he explains.

Fisher also highlights the role of bispecific antibody therapies like glofitamab-gxbm (Columvi) and epcoritamab (Epkinly), which may offer a more accessible treatment option for centers not fully prepared to handle the intensive monitoring required by CAR T-cell therapy. Glofitamab is approved for a limited treatment duration of 9 months, and epcoritamab, which is approved for indefinite use, are both effective alternatives. However, in practice, indefinite therapy can be challenging to implement, and Fisher suggests that many clinicians may opt for limited treatment duration with both agents.

A key strategy for simplifying the integration of these therapies is step-up dosing, Fisher continues. Step-up dosing, particularly with bispecific antibodies like epcoritamab, can help mitigate the risk of severe CRS and allow for outpatient administration. Fisher explains that optimizing this approach may significantly reduce the need for inpatient care, easing the burden on healthcare systems while maintaining safety for patients.

As CAR T-cell therapy becomes more established, Fisher concludes that clinicians should focus on gaining expertise in CRS management, selecting appropriate therapies, and exploring strategies like outpatient dosing to make these treatments more accessible. Ongoing advancements in the field, including the development of new agents and combinations, will continue to shape the future of CAR T-cell therapy in oncology practice.