Sequencing Bispecific Antibodies and CAR T-Cell Therapy in Relapsed/Refractory Multiple Myeloma

In this segment, Dr. Peter Voorhees opens the panel discussion on sequencing and patient selection across the multiple myeloma treatment continuum. He presents a case of a 70-year-old patient with relapsed multiple myeloma following quadruplet induction therapy, autologous stem cell transplantation, and lenalidomide maintenance, who is experiencing a first relapse. Dr. Voorhees asks Dr. Luciano Costa how he would approach the choice between CAR T-cell therapy and bispecific antibody therapy in light of the CARTITUDE-4, CARTITUDE-2 Cohort A, and MajesTEC-3 data. Dr. Costa emphasizes that randomized studies evaluating these approaches are not directly comparable and that the available data do not establish a clear hierarchy of efficacy between them. He describes an approach centered on presenting appropriate treatment options, discussing expected outcomes and risks, and incorporating patient preferences into the decision. The discussion highlights how individual patients may place different importance on treatment logistics, time away from home, potential neurologic toxicities, and other risks. Dr. Costa concludes that treatment selection should be individualized rather than based on a predetermined sequence between CAR T-cell therapy and bispecific antibodies.