Dr Godara on the Selection of CAR T-Cell Therapies vs Bispecific Antibodies in R/R Multiple Myeloma

Amandeep Godara, MBBS, a medical oncologist, Huntsman Cancer Institute, assistant professor, Division of Hematology and Hematologic Malignancies, University of Utah, discusses important patient factors to consider when deciding between a CAR T-cell therapy vs bispecific antibody in relapsed/refractory multiple myeloma. Godara also elaborates on the importance of mitigating treatment-related toxicities associated with the administration of bispecific antibodies in this disease setting.

When selecting between CAR T-cell therapy or treatment with a bispecific antibody, whether a patient's relapse can be characterized as aggressive or not should first be addressed, Godara begins. Bispecific antibodies are recommended for the treatment of patients with aggressive relapsed/refractory disease if no other effective therapies are available, Godara states. In this scenario, a bispecific antibody approach could allow patients to begin treatment sooner, thereby increasing the likelihood that they will achieve responses in a shorter period, he explains.

CAR T-cell therapy could also be considered for patients with aggressive relapsed disease, but it may be necessary to use bridging therapies to control the disease during any accompanying delay in product manufacturing, Godara clarifies.

Although bispecific antibodies are a viable option for the treatment of patients with relapsed/refractory myeloma, they are associated with some safety concerns, Godara notes. Opportunistic infections such as pneumocystis, pneumonia, or cytomegalovirus are rarely observed in patients with multiple myeloma, he says. However, bispecific antibodies are linked with a higher incidence of infection in this patient population, Godara says. This risk of infection is further increased with the use of bispecific antibodies in combination with daratumumab (Darzalex) or lenalidomide (Revlimid). Such infections typically occur month to month after treatment initiation, Godara details.

Intensive supportive care measures, such as the administration of anti-microbials or prophylactic intravenous immunoglobulin, can be prescribed to reduce the risk of infection, as well as treatment-related discontinuations or delays, Godara continues.

Therefore, it is important to improve the management of these toxicities before appointing bispecific antibodies as the new standard of care in myeloma treatment, Godara concludes.

Disclosure: Dr Godara reports serving in a consulting or advisory role for X4 Pharma.