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

Lifestyle preferences and baseline health status should be taken into account when deciding between CAR T-cell therapy versus bispecific antibodies for patients with pretreated relapsed or refractory multiple myeloma, explained Lindsey Halbrook, NP-BC, MSN.

READ MORE: Consider Patient Characteristics, Goals When Planning Myeloma Treatment

Halbrook is an advanced practice provider at the Colorado Blood Cancer Institute in Denver. In a recent interview with Oncology Nursing News, she weighed the pros and cons of each type of therapy, mentioning that although bispecific antibodies may tend to be less toxic, patients have to come into the clinic each week to receive them. Conversely, CAR-T cell therapy tends to have an intense toxicity and monitoring period upfront, but then patients do not need to undergo maintenance therapy.

Providers should also consider the health status of patients. For example, patients who already struggle with weight loss or appetite difficulties may not be good candidates for the bispecific antibody, talquetamab (Talvey), as the drug may exacerbate those conditions.

Transcript:

Because CAR T-cell [therapies] are approved for earlier lines, sometimes that's the best option, especially depending on how many lines of therapy a patient has had. In my experience too, sometimes the CAR T-cell may not be the best option for a patient, so then the bispecific therapy is actually a better choice.

I feel [that] we sometimes tend to see a little less side effects with the bispecific [therapies] so if a patient is able to come into clinic every week for a visit and treatment, then that can be more feasible. … Some of it is the lifestyle approach of, what does a patient want to get out of this? Are they OK with getting this CAR T-cell therapy that's a lot of intensive monitoring in the beginning, but then they don't have any maintenance treatment, so then they can go off and live their life after getting it? Versus the bispecific, where you're seeing a patient every week, or every other week, depending on if you can space the therapy out too.

Also … like with talquetamab, there are a lot of side effects that come with it. So we have even steered away from it sometimes if a patient's already struggling with like weight loss or appetite, because … you're going to make it worse and that's not ideal for some people. Those are some of the things to think about, too.