Dr Suvannasankha on Bispecific Antibodies in Multiple Myeloma

Attaya Suvannasankha, MD, associate professor, clinical medicine, Indiana University School of Medicine, discusses future research directions with bispecific antibodies in patients with multiple myeloma and potential methods for mitigating adverse effects (AEs) in this population.

Dr Suvannasankha on the Future of Bispecific Antibodies in Multiple Myeloma

Bispecific antibodies are contributing to a promising future for multiple myeloma treatment, and moving these agents to earlier lines would decrease the time patients would need to wait to receive these treatments, Suvannasankha says. Mitigating cytokine release syndrome (CRS), which may be accomplished through CD3 affinity adjustment, is key for safely administering bispecific antibodies in this population, and should be explored further, Suvannasankha explains. For instance, in a first-in-human phase 1/2 trial (NCT04083534), treatment with the BCMA-directed bispecific antibody REGN5459, which has a low affinity to CD3, resulted in grade 1, 2, and 3 CRS in 46.5%, 2.3%, and 4.7% of patients, respectively, with no reported instances of grade 4 or 5 CRS.

Bispecific antibodies are also under investigation in other cancers, and the safety benefits of CD3 binding adjustments may be broadly applicable beyond multiple myeloma, Suvannasankha notes.

Dr Suvannasankha on Anticipating and Mitigating AEs With Bispecific Antibodies in Multiple Myeloma

As bispecific antibodies are becoming a new standard of care (SOC) for patients with multiple myeloma, mitigating common AEs associated with these agents, such as CRS, is important to ensure the safe delivery of these therapies—particularly in older or frail patients, Suvannasankha says. Additionally, infection is a common AE associated with bispecific antibodies because patients are often immunocompromised by the time they are eligible to begin these treatments, Suvannasankha explains. Moving bispecific antibodies to earlier lines would allow patients to receive these agents while their immune systems are stronger, Suvannasankha emphasizes.

Beyond managing infections, infection prevention is another important practice; this can include proactively watching for infections, as well as administering intravenous immunoglobulin infusions, which have become a SOC in patients whose antibody levels fall when they receive bispecific antibodies, Suvannasankha concludes.