Clinical Relevance
- Both bispecific antibodies and CAR T-Cell Therapy are advancing immunotherapies that effectively target diffuse large B-cell lymphoma, by mobilizing the immune system against cancer and assisting when other lines of treatment stop working.
- They share known immune-related side effects that your team is trained to recognize and treat quickly.
- These forms of treatment are often considered complementary, rather than mutually exclusive.
Two Powerful Immunotherapy Tools
Both bispecific antibodies and CAR T-Cell Therapy are part of a growing category of immunotherapies—treatments that harness the immune system to fight cancer—that can be effective in fighting diffuse large B-cell lymphoma. They share similarities, including some overlapping side effects, and they are not an either-or choice. Many patients may receive one and later the other as part of a longer treatment journey.“Often we consider bispecifics as complimentary therapies to CAR T-Cell Therapies and not necessarily mutually exclusive therapies,” explains Dr. Sai Pingali, a medical oncologist at Houston Methodist Hospital in Houston, Texas, who specializes in treating non-Hodgkin lymphoma.
Read MoreHow Each Therapy Works
Bispecific antibodies are “off-the-shelf” medicines (ready at the hospital pharmacy) that grab a T-cell (a disease-fighting white blood cell) with one “arm” and a cancer cell with the other “arm,” bringing them together so the T-cell can kill the cancer (think of them as matchmakers for your immune system).“Bispecifics are great therapies which are now approved for various B-cell non-Hodgkin’s lymphomas and also other conditions like myeloma. They are similar to CAR T-cell therapy in terms of the side effects, but they are also given to patients who may not be candidates for CAR T-cell therapy,” says Dr. Pingali.
CAR-T Cell Therapy is made from your own T-Cells. Your cells are collected, sent to a lab, engineered to better recognize cancer (the “CAR” is the new GPS), multiplied, then infused back. It is highly individualized, but it takes weeks to manufacture as opposed to bispecific antibodies. Many FDA-approved CAR-T products in lymphoma target CD19, another marker on B-cell cancers.
RELATED: Key Insights for Patients Considering CAR T-Cell Therapy
Expert Resources on Non Hodgkin Lymphoma
- All About Biopsies to Diagnose Non-Hodgkin Lymphoma
- All About Follicular Lymphoma: A Common Type of Non-Hodgkin Lymphoma
- Bispecific Antibodies Deliver One-Two Punch to Non-Hodgkin Lymphoma
- CAR-T Therapy is a Game-Changer for Common Type of Non-Hodgkin Lymphoma
- Could New Non-Hodgkin Lymphoma Drugs Mean Less Chemo in the Future?
- Making a Plan After Non-Hodgkin Lymphoma Relapse
Do Bispecifics and CAR T-Cell Therapy Compete or Complement Each Other?
According to Dr. Pingali, “[Bispecifics] target the CD20 target on the lymphoma cells and the CAR T-Cell Therapy targets the CD19 on the lymphoma cells.”
Therapies can target different markers on cancer cells with CAR T-Cell Therapy, often targeting CD19 while many bispecifics target CD20. This distinction creates opportunities to:
- Sequence them (use one after the other)
- Use bispecifics as “bridging therapy” while waiting for CAR T-Cell Therapy
- Potentially combine them in future treatment strategies
“We can use them in tandem if need be, and there are a lot of studies that are looking at both of these options to help our patients get to remission and increase the success rate of these treatments, particularly the CAR T-cell therapy success rate and also the improved outcomes of frontline therapies,” Dr. Pingali explains.
WATCH: Every Week Counts: What To Expect When Preparing For CAR T-Cell Therapy
Treating Patients With Both Bispecifics and CAR T-Cell Therapy
Because CAR-T and bispecifics attack cancer cells in different ways (CAR T-Cell Therapy often targets CD19, while bispecifics often use CD20), there is a real opportunity to sequence or combine them. For instance, a physician might use a bispecific antibody first to reduce tumor burden (making the disease smaller and more controllable), then move to CAR-T when ready, or use a bispecific as a “bridge” while waiting for CAR-T to be manufactured.
Some studies have already shown that bispecifics can work in patients who’ve had prior CAR T-Cell Therapy, and vice versa. In other words, a patient who doesn’t respond to CAR T-Cell Therapy might still benefit from a bispecific, and patients who start with bispecifics might later proceed to CAR-T, if eligible.
Another rationale: because CAR T-Cell Therapy takes weeks to prepare, patients with aggressive disease might not be able to wait. Bispecifics can act during that waiting period and help keep the disease under control, improving the chance that patients can survive the delay until CAR T-Cell infusion. Many oncologists call this “bridging.”
Emerging research is also testing combination strategies — giving bispecifics along with other immunotherapies or targeted agents in newly diagnosed patients or earlier lines of treatment to improve outcomes.
“CAR T-Cell Therapy could take eight weeks on average to get to. So we need some other treatment for our patients, which sometimes is bispecifics,” says Dr. Pingali.
“Hence, I call them complementary therapies to each other rather than mutually being exclusive to each other,” he adds.
What to Ask Your Doctor
- Given my exact cancer and prior treatments, which option is likely to help me now—bispecific, CAR-T, or a sequence of both?
- If we’re planning CAR-T, do I need a bispecific as ‘bridging’ while we wait?
- How do the side-effect plans differ—what should I watch for at home, and when do I call?
- If the first option stops working, what’s the next step—can we switch to the other?
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