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Bi-Specific T-cell Engager (BiTE) for Multiple Myeloma

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Published on July 28, 2020

Can BiTE Therapy Be Used to Treat Myeloma?

BiTE is an infusion therapy that activates a patient's own t-cells to help kill cancer cells and is showing promise as a treatment for myeloma. There is some evidence that if a patient's t-cells are compromised, Antibody drug conjugaets (ADC) might offer a better result. Dr. Joshua Richter, Assistant Professor of Medicine, Division of Hematology and Medical Oncology, Tisch Cancer Institute, Mount Sinai School of Medicine and Patient Power co-founder, Andrew Schorr discuss ongoing Bi-Specific T-cell Engager trials.

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Transcript | Bi-Specific T-cell Engager (BiTE) for Multiple Myeloma

Andrew Schorr:

Hello and welcome to Patient Power. I'm Andrew Schorr. Joining us is a noted researcher from New York City, Dr. Joshua Richter from Mount Sinai. And one area of research is not just monoclonal antibodies but bispecific. Am I getting it right? Bimodal? What are you calling it? But it's kind of like a two-for-one kind of thing. Please explain it to us and what it could mean for myeloma patients.

Dr. Richter:

Sure. There's actually several terms that are interchangeable for us, one is bispecific, the other is BiTE, which stands for bispecific T-cell engager. Essentially what it is, is ... I think a lot of us are familiar with monoclonal antibodies. It's an antibody drug that we make that has one arm that attaches to the cancer cell and tries to kill it.

What a bispecific is, is it's got two arms, and one attaches to something that's on the cancer cell, and the other attaches to something that's on our own T-cells, our own immune cell. It's called CD3. It's on all T-cells. And it basically is, when we give this drug as an infusion, it grabs onto the cancer cell, grabs onto our own immune cells, activates our immune cells, and helps it to kill the cancer cell.

These drugs are very exciting because they're off-the-shelf products. We have a lot of great advancements coming down the pike with things like CAR Ts, but for the moment they need weeks to manufacture, and oftentimes patients progressing need therapy today. This type of drugs could provide that type of immune activation in an off-the-shelf product, and we're extremely excited about that.

Andrew Schorr:

Okay, so you're a researcher for that. So, people need to have healthy T-cells? I mean, what's the requirement of the patient so they can respond to this approach?

Dr. Richter:

That's actually a really great question. We don't have all of those answers exactly yet. When we have antibody drugs, there's a lot of different strategies. It may be that for people with T-cells that are kind of tired from fighting, an antibody-drug conjugate may be better, so where you give an antibody drug and it injects the cancer cell with a poison.     

But it may be that people with more healthy T-cells or more robust ones, the bispecific may be a better approach because it can really rev up the immune system, but many of these trials, which are really exciting, are only in phase I and phase II. So, we don't have that granularity just yet, but we now have bifunctional antibodies that target many different targets, so we have a lot of different ways of actually sequencing these drugs.

Andrew Schorr:

All right, so people maybe already have had some myeloma therapy. So, is there something that's going to exclude them, or do they have to be a newly diagnosed patient? Who could be in your trial?

Dr. Richter:

It's a really great question. It really depends upon the target of the bispecific. We all start off with that CD3, but we have CD3 and BCMA bispecifics, and many of those protocols will exclude you if you've had a prior treatment that targets BCMA, like a CAR T or the drug BelMaf, which is about to be approved. We have a CD3/CD38 bispecific. For those back-patient trial, we actually allow people who have had prior CD38 therapy with drugs like isatuximab (Sarclisa) or daratumumab (Darzalex).

We have another one targeting CD3 and GPRC5D. There are no other drugs approved for that yet, but if you had a prior GPRC-targeting therapy, you won't be eligible. And we have a brand, brand new one that we're opening next week that targets something called FcRH5. And, despite all this gobbledygook of different names and letters, each one of these targets are on all plasma cells. So, we can give one that targets this, and then one that targets that, and then one that targets that.

Andrew Schorr:

Wow, okay. So, just to make this hit home for people, that's something to discuss with a researcher such as yourself, whether a BiTE trial for this approach, bispecific, might apply to you, and you're excited about it.

Dr. Richter:

Extremely excited about it, and one of the biggest reasons I'm excited about it is the kind of global landscape of myeloma. The average age of a myeloma patient is 69 years old in this country, which means half of our patients are 70 and older. CAR Ts are very exciting therapy, but some of them may have quite a bit of toxicity. This may be a new way to harness our own immune system to attack the cancer without taking some of those bigger risks, and in turn may be more applicable to your average patient.

Andrew Schorr:

All right. Bispecific, BiTEs, whatever you want to call it, talk to your doctor about it. Talk to your myeloma specialist researcher about it and see if this applies to you. Dr. Joshua Richter from Mount Sinai in New York, thank you so much for being with us.

Dr. Richter:

My pleasure.

Andrew Schorr:

I'm Andrew Schorr. Remember, knowledge can be the best medicine of all.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

 


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