Dr Naik on the Evolving Role of Bispecific Antibodies in Multiple Myeloma

Seema G. Naik, MD, associate professor, Department of Medicine, Division of Hematology and Oncology, Bone Marrow Transplantation Team, Leukemia and Lymphoma Team, Penn State Cancer Institute, discusses the evolving role of bispecific antibodies in hematologic malignancies.

In the realm of myeloma treatment, the integration of bispecific antibodies and other targeted therapies, such as CAR T-cell therapy, has heralded a new era of patient care, Naik begins. Although Naik’s therapeutic preference leans toward the standard autologous stem cell transplant (ASCT) approach—comprising initial induction therapy followed by ASCT and subsequent maintenance therapy—this method may not be universally suitable. For patientswho are ineligible for ASCT, an alternative regimen, carfilzomib, lenalidomide, and dexamethasone (KRd), has emerged, and various clinical trials have demonstrated the efficacy of this approach, she explains.

However, the role of bispecific antibodies becomes increasingly apparent in the difficult-to-treat population of patients with relapsed/refractory, triple-refractory, or penta-exposed disease, for whom therapeutic options are limited, she continues. Notably, CAR T-cell therapy has emerged and offers these patients a pathway to remission, Naik notes. However, questions emerge regarding patients’ treatment trajectories from CAR T-cell therapy to bispecific antibodies. CAR T-cell therapy presents challenges related to accessibility. Not every eligible patient has the opportunity to undergo this innovative treatment due to logistical and resource limitations, Naik emphasizes. The process of cell collection and preparation, as well as the concern about CAR T persistence in patients with a smaller tumor burden, further accentuates the need for viable alternatives to CAR T-cell therapy, wherein bispecific antibodies come into focus, Naik elucidates.

The ongoing exploration and development of bispecific antibodies may diversify treatment options and enhance the therapeutic armamentarium available for addressing the intricacies of myeloma across a broader spectrum of patients, Naik states. As research progresses, the integration of these approaches, tailored to patient profiles and disease characteristics, holds the potential to redefine the standard of care, Naik concludes.