Prophylactically administering tocilizumab before bispecific antibody treatment can slash the incidence of cytokine release syndrome (CRS) from ~75% down to 20%. This simple intervention, analogous to using G-CSF for neutropenia, mitigates side effects and makes outpatient administration a much safer and more feasible option for patients.
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A modified three-step-up dosing schedule for epcoritamab drastically reduced cytokine release syndrome (CRS) rates to 26%, with no severe events. This safety profile supports fully outpatient administration, making this highly effective regimen accessible to community practices without immediate hospital access.
Beyond efficacy, new therapies like bispecifics require significant institutional support. Clinicians need training for unfamiliar side effects like CRS, and facilities need resources like observation units and admission protocols, creating a steep implementation curve for clinical practice.
Unlike T-cell engaging therapies, the bispecific antibody zanidatumab does not cause cytokine release syndrome (CRS). This unique safety feature is because it binds to two distinct sites on the HER2 receptor itself, rather than engaging T-cells, providing a key toxicity advantage.
The rapid and successful rollout of complex bispecific therapies into community settings is primarily driven by enhanced nursing staff skills and protocols for risk stratification. This combination allows for safe outpatient administration, preventing hospital admissions and broadening patient access beyond large academic centers.
In follicular lymphoma, the treatment goal is durable remission with manageable toxicity, not necessarily a cure. Therefore, clinicians frequently prefer using a bispecific antibody first, reserving the more complex and toxic CAR-T cell therapy for transformed disease or after a bispecific fails.
To manage the common side effect of stomatitis from datopotamab deruxtecan (Dato-DXd), a preemptive strategy is effective. Prescribing steroid mouthwash and advising patients to use ice chips during infusion can reduce the severity and incidence of this toxicity.
Subcutaneous on-body device delivery of anti-CD38 antibodies like isatuximab nearly eliminates the high risk of infusion-related reactions common with intravenous administration, especially during the first dose. This significantly enhances patient safety and comfort in the clinic.
While Tumor Lysis Syndrome with venetoclax in newly diagnosed AML is rare, clinicians should be aware of a different, insidious complication: a potentially severe Cytokine Release Syndrome (CRS)-like reaction, particularly in patients with monocytic leukemia.
Using a BCMA bispecific antibody first can exhaust a patient's T-cells or cause tumors to lose the BCMA target, rendering a subsequent BCMA-targeted CAR-T therapy ineffective. The optimal sequence is CAR-T first, which preserves T-cell function and BCMA expression, leaving bispecifics as a viable later-line option.
To manage hypogammaglobulinemia from bispecific antibodies, clinicians are adopting a more proactive approach. Following the model from myeloma care, they are initiating IVIG therapy earlier to prevent infections, rather than waiting for recurrent infections to occur as was standard with rituximab.