'The HemOnc Pulse' Live: Unpacking Bispecifics

“The HemOnc Pulse” was live for the first time in Chicago, Illinois, on May 3-4 and featured host Chadi Nabhan, MD, MBA, FACP, moderating panels of academic and clinical experts who delved into unanswered questions in a range of hematologic malignancies.

As part of the program, Michael Bishop MD, of the University of Chicago, and Aaron Goodman, MD, of the University of California, San Diego, were joined by Rafael Fonseca, MD, of the Mayo Clinic, to hold a panel on bispecific therapies and explore unanswered questions related to them.

Dr. Fonseca, who presented during the panel, noted that the whole class of bispecifics “comes from one unique, fortunate happenstance that we have in myeloma and B-cell tumors, and that is B cells are dispensable. Of course, it’s not ideal to live without B cells, but you can live without B cells.”

Dr. Fonseca further explained that this is a major differentiator for bispecifics compared with immunotherapy in other conditions.

Three bispecifics have already been approved: teclistamab, elranatamab, and talquetamab; however, Dr. Fonseca noted “there’s a lot of experience and wisdom and additional trials that need to be conducted to optimize the use of these agents.”

Much of the discussion naturally drew comparisons between bispecific monoclonal antibodies and chimeric antigen receptor T-cell (CAR-T) therapies.

“What if I’m bridging somebody with teclistamab—we’ve been considering that in our own institution—and they go into a [complete remission]?” Dr. Bishop started. “I would have a hard time taking them to CAR T-cell therapy at that point in time; it might actually be a good strategy to see what kind of responses [occur] because if production continues to take six to eight weeks, we probably will have time to assess what is going on.”

Dr. Bishop also noted there may be opportunities to combine bispecifics and CAR-T therapies.

Dr. Goodman raised potential questions surrounding cost and administration of bispecifics, noting that there are agent-specific rates of cytokine release syndrome (CRS) and that his institution schedules admission for patients based on when CRS historically has occurred with each patient’s agent.