Choosing Between CAR T-Cell Therapy and Bispecific Antibodies in Multiple Myeloma Treatment

At the 2024 Great Debates and Updates (GDU) in Hematological Malignancies in New York, New York, Joseph Mikhael, MD, MEd, FRCPC, FACP, Translational Genomics Research Institute, Phoenix, Arizona, shares expert insight on when to choose chimeric antigen receptor (CAR)T-cell therapy versus bispecific antibodies in multiple myeloma (MM) treatment.

Transcript:

Dr Mikhael: My name is Dr. Joseph Mikhael. I'm a professor at the Translational Genomics Research Institute.

Lymphoma, Leukemia & Myeloma Network: How should oncologists choose between CAR T-cell therapy and bispecific antibodies when treating patients with multiple myeloma?

Dr Mikhael: This is such an important discussion right now of deciding between CAR T-cell therapy and bispecific antibodies, and with a little bit tongue-in-cheek, my answer to that question is typically, "I want it all," right? All of the above is always my favorite answer to this question.

But, it is important that we distinguish [between] the 2 of them, because some patients are likely to benefit more from a CAR-T and others from a bispecific antibody. Here at the Great Debates and Updates in [Hematological Malignancies meeting]in New York, we've been discussing this all day, as it's such an important topic.

I think the key take-home messages are the following. Number 1, if someone is going to really benefit from CAR T-cell therapy, they have to have disease control going into it. For that patient whose disease is out of control, it may not be the optimal first choice. It may be better to immediately introduce a bispecific antibody because it is able to be introduced so much more quickly.

On the other hand, if a patient may be eligible for both (if available), strategically speaking, we tend to prefer to do CAR-T first, where we recruit the T cells and engage them, and then the patient goes off all therapy [and] has a treatment-free interval of nothing, as I said, “nada.” I love giving “nada” to patients. Then, at [a] relapse, we would consider then a bispecific antibody therapy where we can then engage those T-cells.

If we do the reverse, it may be more difficult to fully collect the T-cells for that patient. As these drugs evolve and our approaches evolve, we want to be able to offer just about every therapy to patients. But right now, that rapidly progressing patient may benefit from a bispecific antibody. On the other hand, we tend to favor trying to give a CAR T before the bispecific antibody.