Bispecific antibody treatment

Bispecific antibodies are a type of cancer drug treatment. They are mainly used to treat blood cancers such as myeloma, lymphoma and leukaemia.

Bispecific means the drug can attach to 2 different cells at the same time:

• One part of the drug attaches to the cancer cell.
• The other part attaches to a type of white blood cell called a T-cell. These are cells in the blood that help fight infection and disease.

The drug holds the cancer cell and the T-cell together. This helps the T-cell recognise and attack the cancer cell.

This type of treatment may be described in different ways. Your cancer team might use the name or brand name of your drug. For example:

• blinatumomab (Blincyto®)
• elranatamab (Elrexfio®)
• epcoritamab (Tepkinly®)
• glofitamab (Columvi®)
• teclistamab (Tecvayli®).

Other terms to describe bispecific antibodies include:

• bispecific monoclonal antibodies
• BsAb or BsmAb
• bispecific T-cell engager or BiTE
• targeted therapy or immunotherapy.

Some bispecific antibody drugs are given as a drip into a vein. This is called an intravenous infusion. Others are given as an injection under the skin. This is called a subcutaneous injection.

Bispecific antibody drugs may be given with other cancer drugs. Your cancer team can explain what to expect.

You will usually stay in hospital for your first few treatments so your cancer team can monitor you closely. You may be able to have later treatments at a day unit or clinic as an outpatient.

Some side effects happen because bispecific antibodies make the immune system active. You can usually manage these safely with support from your cancer team. There are treatments that can help.

Side effects are important to know about because they can become serious without treatment. They include the following.

This side effect happens because the bispecific antibody drug makes the body release large amounts of cytokines. Cytokines are chemical messengers that help the body fight infection and illness.

You may have flu-like symptoms while you are having the drug, or hours or days later. Symptoms can range from mild to severe. You may need treatment and close monitoring in hospital until they improve.

CRS is most likely to happen the first few times you have a bispecific antibody. But it can also happen later. If you have any of the following symptoms during or after treatment, contact the hospital straight away on the 24-hour number:

• a temperature of 38°C or above
• feeling hot or flushed
• chills or shivering
• a skin rash
• a fast heart rate
• feeling dizzy or sick
• a headache
• muscle or joint pain
• difficulty breathing or shortness of breath.

Rarely, bispecific antibodies can cause temporary effects on the brain. This is called neurotoxicity or immune effector cell-associated neurotoxicity syndrome (ICANS).

Side effects are usually mild – for example, handwriting changes or feeling confused. But they can become serious without treatment and support. Some people will need treatment in intensive care until the symptoms improve.

ICANS is most likely to happen the first few times you have a bispecific antibody. But it can also happen later.

If you have any of the following symptoms after you go home, contact the hospital straight away on the 24-hour number:

• difficulty speaking, writing or doing fiddly tasks, such as fastening buttons or tying shoelaces
• drowsiness or extreme tiredness
• memory loss, confusion or disorientation
• tremors, shaking or muscle weakness
• loss of balance
• headaches
• seizures (fits).

You must not drive if you have these side effects. Your cancer team may also tell you not to drive or use heavy machinery when you start bispecific antibody treatment. Follow their advice carefully.

You are more likely to get infections during and after finishing bispecific antibody treatment. You also have a higher risk of serious illness from infection.

To reduce your risk of getting an infection, your cancer team may give you:

• antibiotics and other drugs to take during your treatment
• ongoing antibody injections or drips.

It is important to get any infection treated as soon as possible. If you have any of the following symptoms, contact the hospital straight away on the 24-hour number:

• a temperature above 37.5°C
• a temperature below 36°C
• you feel unwell, even with a normal temperature
• you have symptoms of an infection.

Symptoms of an infection include:

• feeling shivery and shaking
• a sore throat
• a cough
• breathlessness
• diarrhoea
• needing to pass urine (pee) often, or discomfort when you pass urine.

It is important to follow any specific advice your cancer treatment team gives you.

Bispecific antibody treatment can cause a sudden, temporary worsening of cancer-related symptoms at the start of treatment. This is called tumour flare reaction.

Always tell your cancer team if you notice any new or suddenly worsening symptoms. They can give you painkillers and other drugs to help.

If you need information about a specific bispecific antibody, you can check our cancer treatments and drugs A to Z. We have detailed information about many types of cancer drugs and their possible side effects.

You can also talk to your cancer team if you want more detailed information about a treatment. Or visit the electronic medicines compendium (emc), which has patient information leaflets (PILs) for individual drugs.

If you want to explore more information about treatment and side effects, you can visit our cancer treatment forum. Our Online Community is a place to talk with others having treatment, share your experience, and ask questions.

We also have information about treatment in our booklets:

• Ask about your cancer treatment
• Side effects of cancer treatment
• Making treatment decisions.