Ask the Nurse: Myeloma and bispecific antibodies

Many myeloma patients, their friends and family like to keep up with the latest myeloma research and are particularly interested in newly available treatments, or in treatments in development.

Immunotherapy treatments are treatments which can harness a patient’s own immune system to kill myeloma cells. Bispecific antibodies, sometimes known as T cell engagers, are a group of immunotherapy drugs which are currently showing great promise in improving remissions for patients.

This month, we are exploring some of the questions we are asked on the Myeloma Infoline about bispecific antibodies.

What are bispecific antibodies?

Bispecific antibodies (also known as T cell engagers) are a type of immunotherapy that help the immune system to recognise and kill cancer cells. You can read more about the different types of immunotherapies in myeloma in our Infosheet. There are several bispecific antibodies for myeloma at different stages of development.

Bispecific antibodies are produced in a laboratory and they are specifically created to bind to proteins on two different types of cells – myeloma cells and a person’s own T cells.

What are T cells?

T cells are white blood cells which are a part of our immune system. They move around our bodies looking for abnormal, infected or potentially harmful cells. When a T cell identifies a harmful cell, it attaches to the cell and either kills the cell directly or sends out a signal to the rest of the immune system to kill the cell.

How do bispecific antibodies work?

A bispecific antibody developed for myeloma has proteins which specifically attach to:

  •  A protein found on the surface of myeloma cells
  •  A protein found on the surface of T cells

This allows the bispecific antibody to bind to both a myeloma cell and a patient’s T cell (see figure below), bringing the T cell into close contact with the myeloma cell. This activates the T cell, allowing it to kill the myeloma cell.

Different bispecific antibody drugs target different surface proteins on the two cells.

Are there any bispecific antibodies available for myeloma in the UK?

In June 2024, the first bispecific antibody to be approved for use in the NHS in England and Wales was announced. You can read more about elranatamab’s approval in our blog.

Bispecific antibodies are of ongoing interest in myeloma clinical trials, as monotherapy (on its own) or in combination with other treatments. There are presently several bispecific antibodies at different stages of development. Read our Clinical trials and how treatments are developed Infoguide to learn more.

Access to bispecific antibodies still in development is usually limited to clinical trials. If you are interested in finding out about currently recruiting clinical trials, visit our Myeloma Trial Finder.

Are bispecific antibodies the same as CAR-T cell treatments?

Whilst both CAR-T cell treatments and bispecific antibodies work by harnessing the patient’s immune system and can use the same targeted proteins to bind to myeloma cells, they are not the same. They are made differently and work in different ways.

CAR-T cell treatments are made from a patient’s own cells. T cells are taken from the patient’s blood, manufactured into CAR-T cells in the lab, and given back to the patient via an infusion (through a drip). The CAR-T cells can bind directly to myeloma cells and kill them. To find out more, check our  Ask the Nurse blog about CAR-T cell treatments.

Bispecific antibodies are not made from T cells and are not made from a patient’s cells but created completely in a laboratory. They work with the patient’s own T cells already circulating in the body, to try and help kill myeloma cells. There is no need for the T cell harvesting and infusion process.

What side effects can bispecific antibodies cause?

Like all drugs, bispecific antibodies can cause side effects, but these can affect everyone differently. If you begin treatment with a bispecific antibody, you may not get all the side effects mentioned here, or may get others not listed:

  • Lowered levels of the healthy blood cells (cytopenia)
  • Infections
  • Gastrointestinal symptoms like nausea, diarrhoea and constipation
  • Neurological side effects (such as delirium and confusion)
  • Cytokine release syndrome (CRS), a potentially serious immune response which can cause symptoms like fever, shortness of breath and changes in blood pressure
  • Fatigue
  • Damage to nerves (peripheral neuropathy)

Some of these side effects can be potentially serious, but you will be monitored frequently for early signs of side effects and given rapid care and supportive treatment if needed. Always mention new or concerning side effects to your healthcare team so that they can offer you the best support for your circumstances.

Why is there currently so much interest in bispecific antibodies?

It is important to have a variety of effective myeloma treatments available to treat myeloma. This is because myeloma is a very individual condition and different people respond to differently to treatments, and because myeloma cells can become resistant (refractory) to some treatments.

Making sure that there are a variety of different treatments available for use helps to provide options and make sure every patient gets the best treatment possible.

Bispecific antibody treatments add to this variety and many bispecific antibodies have been shown in clinical trials to be highly effective, offering many patients long remissions and with manageable side effects.

Unlike some emerging immunotherapies like CAR-T cell treatments, bispecific antibodies are also readily available and have the advantage of being more practical for patients to receive in clinic, without lengthy hospital stays.

To read more about bispecific antibodies, see our Bispecific antibodies Horizon Infosheet or you can read about other immunotherapies in our Immunotherapy in myeloma Horizons Infosheet. For more information about drugs in development, look at our Myeloma Drug Tracker. To learn more about clinical trials currently running and the treatments being tested, visit our Myeloma Trial Finder.

If you have further questions or need support, contact us through the Myeloma Infoline at 0800 980 3332 (UK) or 1800 937 773 (Ireland) or use our Ask the Nurse email service.

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