Bispecific Sequencing, CRS Risk, and CELMoDs: Navigating the Evolving Second-Line RRMM Landscape

In 'Bispecific Sequencing, CRS Risk, and CELMoDs: Navigating the Evolving Second-Line RRMM Landscape,' our panel of experts delve into the following critical questions:

1. Talquetamab showed a higher risk of CRS and tocilizumab use compared to teclistamab in this analysis. In your experience managing patients on bispecific antibodies, how does the CRS risk profile factor into your choice between a BCMA-targeting versus a GPRC5D-targeting agent, and does the treatment setting, such as inpatient versus outpatient step-up dosing, influence that decision?
2. With teclistamab plus daratumumab now approved based on MajesTEC-3, and talquetamab combinations also under active investigation, how are you thinking about the order in which you deploy these agents, and does antigen preservation factor into your reasoning?
3. CELMoDs represent an emerging class with anticipated approvals on the horizon. How are you thinking about where these agents will fit into the second-line treatment algorithm, and how are you preparing for their arrival?

Led by the moderator, the panelists examined how CRS risk profiles factor into bispecific agent selection, with the consensus being that CRS is now a manageable consideration rather than a primary driver of agent choice. The discussion also addressed the nuanced question of antigen preservation and sequencing after CAR-T, with the panelists describing a practical framework that considers the timing of CAR-T progression and highlighting the importance of incorporating non-T-cell-directed therapy intervals to preserve future treatment options. The panelists further explored where CELMoDs are likely to fit into the treatment algorithm, with the consensus being that their ultimate place will depend heavily on approved indications, REMS requirements, and whether T-cell-directed therapies continue to move into earlier lines of therapy.

Throughout the conversation, the experts provide a comprehensive reflection on the field and the factors that may shape how clinicians approach care moving forward.

The next episode in this series, 'The Bispecific Antibody Evolution and the CAR-T Access Imperative,' features the panelists advancing their conversation on multiple myeloma and focusing on how bispecific antibodies may move into earlier lines of therapy, the barriers that continue to limit CAR-T access, the operational advancements and collaborative models that are expanding CAR-T availability for patients across care settings.