Bispecific Antibodies for the Treatment of RRMM in the Post CAR T Setting

Physician Summary: Transitioning from CAR T to Bispecific Antibodies

Transition From CAR T to Bispecific Antibodies:

• If a patient opts for bispecific antibody treatment after CAR T, the decision to go directly from CAR T or use interim therapy depends on the disease progression and patient's clinical status.
• Direct transition from CAR T to bispecifics can be considered if the disease remains responsive or controlled, and there is no delay in access to the bispecific therapy.

• However, interim therapy (eg, selinexor or cytotoxic chemotherapy) might be used if disease progression occurs or there are logistical delays in bispecific antibody access, allowing for disease stabilization before bispecific therapy initiation.

Choosing Between BCMA vs GPRC5D Bispecifics:

• The choice of bispecific antibody depends on target antigen and prior therapy:
• BCMA-directed bispecifics (eg, teclistamab, elranatamab) would be preferred for BCMA-expressing myeloma and in patients previously treated with BCMA-targeted therapies (eg, CAR T) that have relapsed.

• GPRC5D-targeted bispecifics (eg, talquetamab) may be used if BCMA-directed therapies have failed or if patients have no available BCMA target. GPRC5D bispecifics may offer a novel mechanism of action and provide a potential alternative for patients with relapsed or refractory disease.

Key Takeaway: The decision to proceed directly to bispecific therapy or use interim therapy depends on disease status and treatment access. BCMA bispecifics are typically preferred in patients who are BCMA-exposed, while GPRC5D bispecifics offer an option for those with BCMA-relapsed disease.