Clinical Perspectives: Analyzing Real-World Data With Bispecifics in R/R MM

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Real-world bispecific antibody data initially suggested modest efficacy reductions compared with clinical trial results, largely attributed to early commercial use in patients with the most aggressive disease presentations who required immediate intervention. However, subsequent real-world evidence has demonstrated outcomes that more closely approximate clinical trial efficacy, particularly as treatment protocols have been refined and patient selection has evolved. These real-world studies importantly include patients who would not have met strict clinical trial eligibility criteria, demonstrating the broader applicability of bispecific therapies.

Patient selection for bispecific antibodies vs CAR T-cell therapy requires careful consideration of multiple factors, including comorbidity profiles, patient preferences regarding treatment-related risks, and disease tempo. Patients with prohibitive comorbidities for CAR T-cell therapy or those declining CAR T treatment after thorough risk-benefit discussions represent ideal candidates for bispecific antibody therapy. For patients with rapidly progressive disease who remain CAR T candidates, bispecific antibodies serve as effective bridging therapy, with treatment choice influenced by prior therapy exposure and target antigen considerations.

The evolving treatment landscape emphasizes the importance of individualized therapy selection based on comprehensive patient assessment. Real-world data continues to support the effectiveness of bispecific antibodies in diverse patient populations, including those with high-risk features that may have excluded them from initial clinical trials. This broader applicability makes bispecific antibodies valuable tools for community oncologists managing complex relapsed/refractory multiple myeloma cases.