I’m very encouraged by all the abstracts related to bispecifics because they offer a unique way to attack myeloma. As we all know, myeloma is very smart and sly. It continually changes to evade the current treatment and can become more high-risk over time which complicates things even more. Finding new ways to outsmart myeloma becomes ever important as the number of relapses increases.
Ultimately, you never want to run out of lily pads to jump to and this requires novel methods of treatment. Developing new treatments takes years of research and trials before approval is granted.
Bispecifics are one of the most promising new ways on the horizon to fight myeloma. They attack myeloma cells in two ways. First, they identify an antigen expressed on myeloma cells, like BCMA. Secondly, they engage your circulating T cells. All this leads the drug into the malignant myeloma cell resulting in cell death. I first remember a large amount of attention on bispecifics at ASH 2018 and all the buzz was on using the BCMA antigen on the myeloma cells.
Moving forward to 2021, BCMA bispecifics are moving forward and there is also a focus on bispecifics that use different antigens, such as GPRC5D, CD3, and FcRH5, and looking at using bispecifics in combination with existing therapies like Darzalex® (daratumumab). Regardless of the antigen, it needs to be widely expressed on myeloma cells and not on your healthy cells.
There is the promise that in 2022, we will see the Federal Food & Drug Administration (FDA) approval of at least one bispecific. Bispecifics, like all treatments, do come with side effects. We’ve all experienced the typical side effects like fatigue, GI issues, and low blood counts, but bispecifics have a side effect most may not be familiar with — Cytokine release syndrome (CRS). CRS is a syndrome that results from the immune cells being activated and releasing large amounts of cytokines into your body. Cytokines are small proteins that help direct your body’s immune response and large numbers of them increase inflammation in the body. Much has been learned about the treatment of CRS and it has shown to be successfully controlled with medications as needed.
This is a new treatment category that you will want to watch for in the coming months and years. I know it will be discussed in the “IMWG Conference Series – Best of ASH 2021” that you can view online beginning on Monday (https://www.myeloma.org/videos/imwg-conference-series-ash-2021) and the International Myeloma Foundation (IMF) has a terrific video series on “Using Your Immune System To Fight Myeloma” which features a segment on how bispecifics work (Myeloma and the Immune System | Int’l Myeloma Fndtn). As always, knowledge is power!
Linda Huguelet, Chattanooga Multiple Myeloma Networking Group
Linda Huguelet, on Twitter: @LindaMYELOMA