Optimizing Bispecific Antibody Therapy With Linvoseltamab

The bispecific antibody linvoseltamab introduces a patient-centric advancement, with its response-adapted dosing regimen, a flexible approach that aims to reduce the treatment burden for patients while maintaining high efficacy, representing a significant step forward in managing cancer therapy.

Unlike other regimens that might require a week-long commitment at a facility, linvoseltamab’s administration can be more convenient for patients who cannot stay away from home for extended periods. A key feature of its labeled use is the ability to reduce dosing frequency for patients who achieve a very good partial response or better, to once every 2 or 4 weeks. Such areduction in frequency can lessen the burden on patients, which can lead to a significant improvement in quality of life. Although clinicians sometimes adapt schedules for other bispecific antibodies based on experience, having this guidance incorporated directly into linvoseltamab's label is a major advantage.

Like other therapies in its class, linvoseltamab is associated with adverse effects (AEs), primarily cytokine release syndrome (CRS) and infections.

• CRS: Although CRS occurred in 46% of patients in the LINKER-MM1 trial (NCT03761108), it is a manageable and predictable AE. Most cases are mild (grade 1-2), temporary, and can be handled with symptomatic care. Severe (grade 3-4) CRS is uncommon, affecting less than 2% of patients in many studies. The manageable nature of CRS with bispecific antibodies is leading to more treatments being administered in outpatient settings.
• Infections: Infections are a more serious concern, reported in 74% of LINKER-MM1 patients, with 36% experiencing grade 3 or 4 infections. The cumulative risk for severe infections with bispecific antibodies can be around 30% over time.

A critical observation is that infection risk may be related to the therapy intensity. The practice of response-adapted de-escalation, combined with effective antibiotic prophylaxis and the use of intravenous immunoglobulin, has become a key strategy to mitigate infection risk. By optimizing treatment protocols in this way, clinicians can better balance potent efficacy with long-term patient safety.