What’s Next for Bispecifics: Earlier Use and More

Bispecific antibodies in multiple myeloma are currently approved for patients who have undergone at least 4 prior lines of therapy, but their use is rapidly evolving. It is anticipated that these agents will soon be approved for earlier lines of treatment. Potential applications include maintenance therapy after transplant, especially in high-risk patients, and even integration into first-line regimens. The goal in earlier use is to achieve minimal residual disease (MRD) negativity in as many patients as possible, a marker strongly associated with longer response duration and improved long-term outcomes. At present, bispecific antibody therapy is generally administered as continuous treatment, with patients remaining on therapy as long as it is effective and tolerated. However, a key question under investigation is whether treatment can be safely stopped after a certain period, particularly when MRD negativity is confirmed repeatedly. This approach could allow patients to pause therapy and be monitored closely, resuming treatment only upon signs of biochemical relapse. Although definitive answers are not yet available, this strategy offers the potential for more personalized and outcome-driven use of bispecific antibodies. As clinical experience grows and ongoing studies provide more data, it is expected that bispecific antibodies will become a cornerstone of multiple myeloma treatment across various stages of the disease. Their ability to improve response quality and durability, combined with thoughtful integration into treatment protocols guided by MRD testing, promises to enhance patient outcomes while potentially reducing treatment burden. This evolving landscape reflects a move toward more precise and effective management of multiple myeloma.