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Answers to FAQs from our 2/14/24 webinar on bispecific antibodies in multiple myeloma

Does the age of the patient play a role in whether a patient can receive a bispecific antibody?

The age and the performance status of the patient play a role in determining which treatment is selected. Someone who is frail and/or has a poor performance status may be better suited for a bispecific antibody. Whereas a younger patient with a good performance status could be a better candidate for CAR T-cell therapy. There is currently no limit on the age of a patient who can receive bispecific antibody therapy.  Healthcare professionals should have a discussion with the patient to see what is in line with the goals of the patient.

Is it better to have a bispecific antibody first then a CAR-T or a CAR-T first then a bispecific antibody?

That is the million-dollar question. Findings from recent clinical trials have shown that the overall response rate was higher in patients who have received CAR T therapy first.  Generally, the myeloma community believes that you can use CAR-T first and then use bispecific antibody therapy following relapse. If we treat patients with a BCMA-directed bispecific antibody first, the efficacy of a follow-up BCMA-directed CAR-T therapy may not be as strong. However, every situation is unique.  For example, one doctor had a patient who had rapidly progressive disease and needed treatment immediately with a bispecific antibody while the CAR-T was being developed.

What is the most recent data on the efficacy of bispecific antibody therapy for patients with high-risk disease?

While we have moved the needle and improved outcomes for patients with standard risk disease, there is a long way to go when it comes to improving outcomes in patients with high-risk myeloma. That is why we have the MMRF HORIZON platform trials. We need new trials with new designs to see how bispecific antibodies can improve the outcomes of patients with high-risk disease. There is a lot of interest in the community to see how these newer trials can address the unmet need of this patient population.