BCMA-Targeted Bispecific Antibodies: Navigating the New Frontier of Myeloma

For patients with multiple myeloma who have undergone multiple lines of treatment and are refractory to common agents, new therapies offer remarkable hope. With 3 BCMA-targeted bispecific antibodies now competing—linvoseltamab, teclistamab, and elranatamab—clinicians and patients face choices that are not always straightforward, as these agents have not been studied in head-to-head trials. The selection process depends on several practical and clinical factors that include dosing schedule and formulary availability.

Patient tolerance also is crucial; if a patient experiences toxicity from one treatment, it may be possible to switch. Resistance to one BCMA-targeted bispecific antibody does not necessarily preclude a response to another, because the agents can have slight variations in the part of the BCMA protein they target. This competition could potentially drive down the overall cost of care for patients, although this remains to be seen.

Data from the phase 1/2 LINKER-MM1 trial (NCT03761108) led to the July 2025 FDA approval of linvoseltamab. Among heavily pretreated patients, there was a 70% objective response rate (ORR), with 45% of patients achieving a complete response (CR) or better. At a median follow-up of 21.3 months, a 71% ORR was seen, with and 52% of patients achieving a CR or better, and the median duration of response was approximately 29 months.

Progression-free survival has also been promising, ranging from 12 months to nearly 2 years, depending on the agent and study. These responses have also proven to be highly durable, a critical factor for patients with progressive disease.

While the clinical trial data are impressive, direct comparisons between the bispecific antibodies are challenging. The findings from the LINKER-MM1 trial may be very promising, but it's important to recognize that the patient populations in different trials may not be directly comparable. The next critical step will be the emergence of real-world data to provide a more-informed sense of how these molecules perform in a broader patient population.