Bringing Bispecific Antibodies Into Community Myeloma Care

Bispecific antibodies are reshaping the treatment landscape for patients with multiple myeloma, particularly those experiencing early relapse. In this interview, Dr. Rahul Banerjee, Associate Professor at the Fred Hutchinson Cancer Center, speaks with Dr. Hans Lee, Director of Myeloma Research at Sarah Cannon Research Institute, about treatment selection, outpatient administration, supportive care, and the future of time-limited therapy, emphasizing the potential of bispecific antibodies to help more patients receive advanced care in their local communities.

A New Approach at First Relapse

According to Dr. Lee, treatment decisions at first relapse now increasingly include targeted immunotherapies, such as chimeric antigen receptor (CAR) T-cell therapy and bispecific antibody combinations. The choice depends on factors including a patient’s access to a specialized treatment center, treatment preferences, clinical status, and the practical demands of each approach. 

“At this point, I really try to prioritize giving my patient a BCMA-targeted approach at the time of first relapse, either CAR T therapy or a bispecific-based combination,” Dr. Lee said. “This availability has really changed the landscape of how we approach early relapse in refractory multiple myeloma.”

CAR T-cell therapy offers powerful efficacy and the possibility of extended time away from active treatment after a single infusion. However, patients may need to travel and remain near a specialized center during treatment. Bispecific antibodies offer a different advantage: they are available off-the-shelf and may be administered closer to home for many patients.

“One great advantage of bispecific antibodies is their strong efficacy and their availability off-the-shelf,” Dr. Lee explained. “Bispecifics can be administered safely in the community in the patient’s local treatment setting.”

Creating a Safe Outpatient Process 

One of the most important operational challenges with bispecific antibodies is step-up dosing, in which patients receive smaller initial doses before receiving the full treatment dose. This period can involve immune-related side effects, including cytokine release syndrome, and has traditionally led many centers to hospitalize patients for monitoring. 

Dr. Lee noted that outpatient step-up dosing is becoming more feasible as clinicians gain experience and develop coordinated treatment pathways. He recommended that centers assemble a multidisciplinary team, including oncologists, advanced practice providers, pharmacists, infusion nurses, and triage nurses. Together, these professionals can map each stage of the patient journey, establish monitoring procedures, and determine how potential complications will be managed.

He underscored, “I think the most important thing is to assemble the key stakeholders who may be involved in the process and to map out the patient journey step-by-step of how they’re going to go from receiving step-up dosing in the clinic, to being monitored in the outpatient setting, and if adverse events should occur, how to manage those.”

Supportive Care and Dose De-Escalation 

After the initial treatment period, reducing dosing frequency may help limit treatment burden and manage ongoing side effects. Dr. Lee described de-escalation as an important direction for bispecific antibody therapy, particularly as patients achieve deep responses. “I think we all would agree that de-escalation is the way to go,” he said.

Supportive care remains essential throughout treatment. Dr. Lee encouraged clinicians to address infection risk proactively, including the prophylactic use of immunoglobulin replacement and appropriate antiviral and Pneumocystis jirovecii pneumonia prophylaxis. 

For patients receiving talquetamab, clinicians should also prepare for taste changes, dry mouth, and nail or skin toxicities. Supportive care approaches such as moisturizers and artificial saliva, as well as timely adjustment of dosing, may help patients remain on therapy while preserving quality of life.

The Future of Time-Limited Treatment 

The next major question is whether patients need to continue bispecific antibodies indefinitely. Dr. Lee believes fixed-duration approaches could eventually reduce prolonged immune suppression and treatment-related complications. “At some point, once a patient attains a deep response, treatment can be de-escalated. What that duration is, the jury is still out on what that is,” he said.

As Dr. Banerjee summarized, the field now knows that bispecific antibodies can be highly effective. The next step is determining whether clinicians can safely use less treatment while maintaining disease control and improving patients’ daily lives.

Key Takeaways 

• Bispecific antibodies are becoming important treatment options at first relapse of multiple myeloma.

• Community-based outpatient administration may be achievable with careful planning.

• Multidisciplinary coordination is vital for safe and efficient treatment delivery.

• Dose de-escalation may reduce toxicity and improve the treatment experience.

• Future research will help define whether fixed-duration therapy can preserve responses while reducing long-term treatment burden.

About the Speakers

Rahul Banerjee, MD, FACP, is an Associate Professor at the Fred Hutchinson Cancer Center in Seattle, Washington. His clinical interests are in multiple myeloma and CAR T therapy. Dr. Banerjee is a member of the International Myeloma Working Group and has published over 150 peer-reviewed publications with an emphasis on improving the experiences of patients as they undergo treatment for multiple myeloma. 

Hans Lee, MD, is the Director of Myeloma Research at Sarah Cannon Research Institute (SCRI). In this role, he provides scientific leadership and oversight for multiple myeloma clinical trials across SCRI’s network of more than 200 locations in 20 states. Dr. Lee has extensive experience serving as principal investigator for early-phase clinical trials in multiple myeloma and AL amyloidosis. In addition to his leadership role at SCRI, Dr. Lee serves as a medical oncology at SCRI Oncology Partners in Nashville, Tennessee.