Bispecific Antibodies Are ‘Not Your Typical Chemotherapy’ in Myeloma Treatment

“[Bispecific antibodies] are exciting. What they do is great, and I think patients overall have pretty tolerable, if any, side effects," a nurse practitioner said.

The use of bispecific antibodies have brought landmark change for the treatment of relapsed/refractory multiple myeloma, and tend to be well-tolerated, explained Carrie Lechtenberger, APRN, FNP-C, CCM, OCN, CBCN.

“[Bispecific antibodies] are exciting. What they do is great, and I think patients overall have pretty tolerable, if any, side effects,” Lechtenberger, a family nurse practitioner at Levine Cancer Institute, Atrium Health, said.

MORE: Making the Decision: Bispecifics Vs. CAR T-Cell Therapy in Myeloma

In an interview with Oncology Nursing News, Lechtenberger discussed the use of bispecific antibodies—which harness the immune system to find and fight cancerous cells—for patients with multiple myeloma. She discussed adverse effects from this class of drugs, and what nurses and advanced practice providers (APPs) should discuss with their patients before starting them on this type of therapy.

What does education about these drugs look like between the oncology nurses/APPs and the patients and their caregivers? What is important to know before starting bispecific antibody treatment?

Something that's important for patients to know is that although this is not your typical chemotherapy—you're not going to see that hair loss, or maybe the [gastrointestinal] side effects, or some of the things that chemotherapy can bring. [However], there still are side effects.

Bispecifics are working with your immune system. We are ramping up your immune system to identify the cancer, and so there are side effects involved with doing that. I still like to let patients know that you will experience [adverse effects]. Every person is different. It's impossible to say exactly what they'll experience. But I think it's important to teach patients and their loved ones what can be seen, what can be experienced, and what to do when they do experience those side effects.

What are some of the more common adverse effects that you see with bispecific antibodies?

I am a nurse practitioner who is mostly focused on the inpatient clientele. So I'm not first line in the infusion suite, but I am tied to the infusion suite, and so the goal is that I will carry over my role into both.

We mostly see patients with multiple myeloma getting treated with bispecifics here, their side effects [are] maybe a cytokine release syndrome (CRS) that could potentially be grade 1 or grade 2. It's not common, but it can happen. And [immune effector cell-associated neurotoxicity syndrome (ICANS)] can sometimes be something that a patient may deal with, [and can present as] some word-finding issues, confusion. And again, it's not highly common. Those can easily be treated, so we can hopefully mitigate that becoming worse.

What are some of the symptoms to look out for, indicating potential ICANS and CRS, and how is this treated?

So with CRS, sometimes you're going to get chills, or it could progress into rigors. It could be this…overall feeling of not feeling well, and the patient just suddenly feeling like they're declining.

Tocilizumab for CRS is usually a good go-to for the multiple myeloma patients. I think there's still some discussion over, do we do this also with the dexamethasone? Some people will say, yes. I think that that it's still really early, and I think sometimes it's hard to know.

But I would say the tocilizumab, [approximately] 8 mg, is usually a good place to start for that. A steroid seems to be what eventually is a good choice.