How Bispecific Antibodies Work to Treat Multiple Myeloma

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One expert explains how bispecific antibodies are a ‘targeted and effective’ option for patients with multiple myeloma.

Image of a doctor drawing liquid from a vial with a syringe.

Bispecific antibodies can be administered either intravenously or subcutaneously, which is the more convenient option, an expert told CURE®.

Bispecific antibodies offer a “targeted and effective alternative” for the treatment of patients with multiple myeloma, as one expert explained in an interview with CURE®.

Dr. Mansi Shah, assistant professor of medicine in the Division of Blood Disorders at the Rutgers Cancer Institute of New Jersey, spoke via email about the advantages of bispecific antibodies, which work by bringing healthy T cells, part of the body’s immune system, to myeloma cells with the goal, is helping T cells kill the myeloma cells.

LEARN MORE: Bispecific Antibodies Get ‘Fantastic’ Responses in Pretreated Multiple Myeloma

Such treatments, Shah explained, are available “off the shelf,” meaning they don’t have to be manufactured specifically for each patient, and can administered with flexible dosing schedules. However, unmet needs and disparities persist, as Shah detailed in the email interview.

CURE®: How has the field of multiple myeloma treatment evolved in recent years? What are some major advancements that have occurred recently?

Shah: The field of multiple myeloma treatment has seen rapid advancements and significant developments recently. One of the most notable advancements is the advent of chimeric antigen receptor T-cell (CAR-T) therapy targeting B-cell maturation antigen (BCMA). CAR-T therapy reprograms a patient’s own T-cells to recognize and attack myeloma cells, offering a highly personalized and effective treatment option for relapsed or refractory multiple myeloma.

Additionally, novel targets for bispecific antibodies have emerged, including BCMA, GPRC5D, and FcRH5. These bispecific antibodies have shown promising results in clinical trials, and some have received FDA approval, providing new treatment options. The first BCMA-targeted bispecific [Tecvayli (teclistamab-cqyv)] was approved in October 2022 and subsequent approvals have been in August of 2023 for GPRC5D bispecific antibody [Talvey (talquetamab-tgvs)]. Newer bispecific antibodies are designed to more precisely target myeloma cells, improving treatment effectiveness and potentially reducing off-target side effects.

Combination therapies, where bispecific antibodies are paired with other treatments like immunomodulatory drugs and proteasome inhibitors, have demonstrated enhanced efficacy and provide a comprehensive approach to treatment in clinical trials that are currently ongoing. The approval of new therapies and ongoing research are crucial for discovering additional effective treatments and improving patient outcomes. Rutgers Cancer Institute of New Jersey is currently participating in several such clinical trials for people with multiple myeloma.

Are there certain patient populations or points in a treatment journey where bispecific antibodies are a particularly viable option? If so, what and why?

Bispecific antibodies are particularly viable for several patient populations and stages in the treatment journey. They are an “off-the-shelf” option, meaning they can be administered without the need for individualized manufacturing, unlike CAR-T cell therapy. This allows for a quicker start to treatment, which is crucial for patients who cannot wait for the lengthy production process of CAR-T cells due to logistical or medical reasons.

Patients who have relapsed or refractory multiple myeloma often benefit from bispecific antibodies, especially those who have exhausted other treatment options. Bispecific antibodies provide a targeted and effective alternative. They also offer flexible dosing schedules, which can be adjusted based on the patient's response and tolerance. Administration can be subcutaneous [under the skin] or intravenous [through a vein], with subcutaneous administration often being preferred for its convenience and potentially fewer side effects. One of the key benefits is the ability to see responses to treatment quickly, which is vital for managing the disease and improving the patient’s quality of life.

Are there any unmet needs, disparities, or inequities that persist regarding access to and utilization of treatment via bispecific antibodies for patients with multiple myeloma? If so, what?

Despite the advancements, several unmet needs and disparities persist. Effective use of bispecific antibodies necessitates a multidisciplinary team, including pharmacists, nurses, physicians, social workers and nutritionists. Ensuring all team members are equipped to recognize and manage side effects is crucial but can be challenging, especially in resource-limited settings. Inpatient monitoring for step-up dosing regimens can strain hospital resources and limit bed availability, impacting the ability to treat other patients.

Access to treatment remains unequal due to geographic, economic or healthcare system barriers, particularly in rural or underserved areas. The high cost of new therapies can limit access, with insurance coverage varying significantly. Patients without comprehensive insurance may struggle to afford these treatments.

Furthermore, there is a need for better education and awareness among patients and healthcare providers about the availability and benefits of bispecific antibodies. Ensuring that patients are informed about all their treatment options is essential for equitable care.

Addressing these issues requires coordinated efforts to ensure all patients have equitable access to the best possible care. This involves improving training, enhancing multidisciplinary collaboration, ensuring adequate resources and addressing financial and educational barriers.

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