Comparison of anti-BCMA modalities
| . | CAR-T cells . | Bispecific antibodies . | ADCs . |
|---|---|---|---|
| Pros | Unprecedented response rates, including MRD negativity in heavily pretreated patients | Off the shelf | Off the shelf |
| One-time intervention; long chemotherapy holiday, resulting in median PFS ∼1 year | Deep responses | Encouraging response rates | |
| Limited severe CRS; ? elderly | 1-hour infusion every 3 weeks | ||
| Can be given in community settings | No CRS | ||
| Can be given in community settings | |||
| Cons | Manufacturing time makes it impractical for patients with aggressive or rapidly progressing disease | ? Need for admissions with initial doses until CRS risk is low | Ocular toxicity; requires close collaboration with ophthalmology and may negatively impact quality of life |
| Requires complex infrastructure, with a stem cell laboratory and nursing and ICU/ER training; thus restricted to accredited centers | Limited data in triple class/pentarefractory | Thrombocytopenia | |
| CRS; ? role in elderly and frail patients | Dosing/schedule to be determined | Need for continuous treatment until progression | |
| Impact of bridging chemotherapy on duration of remission | Need for continuous treatment until progression | Modest ORR and PFS in triple class/pentarefractory | |
| Cost, given relapses occur, even in MRD− patients | Toxicities require further study; neuropathy, infections | ||
| Low white cells and platelets after CAR-T requiring ongoing/frequent monitoring and treatment | |||
| Management of CAR-T relapses challenging, especially if soon after fludarabine/cyclophosphamide, given impact on T cells |
| . | CAR-T cells . | Bispecific antibodies . | ADCs . |
|---|---|---|---|
| Pros | Unprecedented response rates, including MRD negativity in heavily pretreated patients | Off the shelf | Off the shelf |
| One-time intervention; long chemotherapy holiday, resulting in median PFS ∼1 year | Deep responses | Encouraging response rates | |
| Limited severe CRS; ? elderly | 1-hour infusion every 3 weeks | ||
| Can be given in community settings | No CRS | ||
| Can be given in community settings | |||
| Cons | Manufacturing time makes it impractical for patients with aggressive or rapidly progressing disease | ? Need for admissions with initial doses until CRS risk is low | Ocular toxicity; requires close collaboration with ophthalmology and may negatively impact quality of life |
| Requires complex infrastructure, with a stem cell laboratory and nursing and ICU/ER training; thus restricted to accredited centers | Limited data in triple class/pentarefractory | Thrombocytopenia | |
| CRS; ? role in elderly and frail patients | Dosing/schedule to be determined | Need for continuous treatment until progression | |
| Impact of bridging chemotherapy on duration of remission | Need for continuous treatment until progression | Modest ORR and PFS in triple class/pentarefractory | |
| Cost, given relapses occur, even in MRD− patients | Toxicities require further study; neuropathy, infections | ||
| Low white cells and platelets after CAR-T requiring ongoing/frequent monitoring and treatment | |||
| Management of CAR-T relapses challenging, especially if soon after fludarabine/cyclophosphamide, given impact on T cells |
ICU/ER, intensive care unit/emergency room.