Shebli Atrash, MD, Levine Cancer Institute medical oncologist and associate professor of medicine at the University of Wake Forest interviewed with Medical Express following his presentation at the 2025 Conference in Orlando Florida. According to Dr. Atrash, immune therapies, including (CAR) T-cell therapies, bispecific antibodies, and T-cell engagers, will have a significant role in the future.
He began by providing background for his presentation, highlighting already approved BCMA antibodies. Specifically, he identified trial findings that revealed approximately 70% as an overall response rate.
Dr. Atrash highlighted the phase 3 MajesTEC-7 trial, lenalidomide (Revlimid), and dexamethasone as well as the phase 3 MAIA trial (NCT02252172). The doctor included the MajesTEC-4 trial Phase 3 (NCT05243797). It is exploring bispecific antibody use in the maintenance setting.
The MajesTEC-4 trial evaluated teclistamab with lenalidomide vs lenalidomide alone. The team found that patients characterized at baseline as minimal residual disease (MRD) negative maintained MRD negativity at cycle 3.
Next, Dr. Atrash noted differences between T-cell engagers and standard therapy emphasizing improved response, durability and fewer adverse effects. Since the biggest disadvantage of these therapies is infections, researchers are evaluating a treatment duration to minimize AEs related to infections.
Dr. Atrash mentioned the need to determine why 30% of patients have no response to treatment. He also mentioned that the US is new to this clinical trial, but it will be open to the US shortly.
Bispecific antibodies can be used as a single agent for induction as they produce a deep response. However, the doctor said to be mindful using MRD as an end point because patients who are high-risk could relapse quickly.
T-cell engagers have brought about changes. They have produced deep responses that have not been seen with other agents.
The advantages of T-cell engagers are:
- fewer adverse effects
- administrating one drug
- a reduction in steroids and
- more durable responses.
The disadvantages of bispecifics are infections which have been common.
Dr. Atrash said the researchers are working to remedy the situation. One example would be using a bispecific antibody to control multiple myeloma and then administer CAR T. Dr. Atrash said that in the first month or two, you get a drop of about 30% in the survival curves. Predicting who belongs in the 30% is important. This involves the host immune system and fitness, as well as soluble BCMA levels.
The panel again discussed efficacy compared to bispecifics. The topic of when to pick CAR T over a bispecific is still evolving. It will largely depend on the available socioeconomic status of the patient, and other panelists.
The therapies are coming to oncology and solid tumor fields as well.
