Selecting Bispecific Antibodies in Relapsed/Refractory Multiple Myeloma

In this segment, Dr. Peter Voorhees discusses treatment selection with bispecific antibodies in relapsed/refractory multiple myeloma, focusing on patients with prior CD38 antibody exposure. He notes that MajesTEC-3 and MonumenTAL-3 did not address patients with CD38 antibody-refractory disease because refractory disease was an exclusion criterion, while discussing the emerging evidence from MajesTEC-9 in this population. For patients with early relapse who are CD38 antibody-naive or previously exposed but not refractory, Dr. Voorhees considers BCMA- and GPRC5D-directed bispecific antibody approaches as potential treatment options. The discussion then focuses on factors that may influence selection between teclistamab- and talquetamab-based therapy. Dr. Voorhees contrasts the infection and hypogammaglobulinemia considerations associated with BCMA-directed therapy with the skin, oral, and taste-related toxicities associated with GPRC5D-directed therapy. He also discusses clinical circumstances that may influence treatment selection, including a history of frequent severe infections or severe pulmonary disease. Finally, he describes a potential role for GPRC5D-directed therapy following relapse after BCMA-directed CAR T-cell therapy.