Opportunities for Earlier Initiation of Bispecific Therapies in Multiple Myeloma

In this episode, experts discuss the rationale and emerging evidence for introducing bispecific antibodies earlier in the treatment course for multiple myeloma. Panelists note that because bispecifics show strong activity in later lines, moving them forward could enhance efficacy before significant clonal evolution and refractoriness develop. They describe different strategies under investigation, including single-agent and combination approaches. Examples include low-dose teclistamab given after three cycles of bortezomib, lenalidomide, and dexamethasone, which produced responses in all newly diagnosed patients studied. Another strategy uses linvoseltamab as induction, followed by transplant and consolidation or continuous treatment for nontransplant candidates. Experts also highlight combination trials such as the elranatamab MagnetisMM-6 study and investigations pairing teclistamab or talquetamab with anti-CD38 antibodies. These efforts aim to determine how bispecifics can be incorporated into first-line or transplant-ineligible settings and may ultimately reshape upfront therapy.