How Does the Availability of CD20 Bispecifics Affect Treatment Decisions?

CAR T-cell therapies are often personalized and require weeks to develop for a specific patient; however, bispecific antibodies, particularly those that target CD20, are immediately available “off-the-shelf” and do not require weeks to prepare.

Surrounding the 2025 Immune Cell Effector Therapy (ICE-T) Congress, CancerNetwork® hosted a panel discussion consisting of several experts in cellular therapies, particularly those in lymphoma. They discussed the implications of this availability for patients with non-Hodgkin lymphoma who are frailer and experiencing rapid progression.

The panel included Forat G. Lufti, MD, assistant professor of Hematologic Malignancies and Cellular Therapeutics at Kansas University Medical Center; Nausheen Ahmed, MD, associate professor of Hematologic Malignancies and Cellular Therapeutics at Kansas University Medical Center; and Sayeef Mirza, MD, MPH, FACP, hematologist/oncologist at Moffitt Cancer Center.

Transcript:

Lufti: Frailty is a huge part of this. With that said, I think we’ve all gotten quite comfortable with CAR T in older and even more frail patients. But obviously, if a patient has very poor functional status or significant comorbidities, that would be prohibitive for CAR T therapy, even though it’s the less toxic construct; then, we certainly would have to give bispecifics. For example, I’ve had some patients who have significant cardiopulmonary issues that are easily correctable or patients who are rapidly progressing [such that] I don’t think I can get CAR T therapy in time, and I absolutely have done bispecifics. It is more [about] frailty. With our CAR T constructs, we’ve been able to get things within about 3 weeks, and generally speaking, we’re able to collect within a few days of seeing the patient if everything is okay with insurance. That has become less of an issue, although there are times when you don’t have a lot of time. The nice thing with having the bispecifics available is that you can initiate them. You can admit a patient who’s in trouble. We can do a rapid ramp-up, so that instead of doing it weekly, with epcoritamab-bysp [Epkinly] we’re doing a day 1, 3, and 5 rapid step-up [dosing schedule] in the hospital. With glofitamab-gxbm [Columvi], it’s more like a day 1, 5, and 7 [schedule]. But we can get that therapeutic approach and get that treatment in quickly. On the flip side, with people who have explosive disease, the other advantage here is that you know very quickly whether they’re going to respond to the bispecific and if you need to switch gears. That is something that can be quite helpful.

Mirza: When it comes to [patients who are ineligible for] CAR T and frail, it’s less of a frailty issue. Usually, it’s more of an access and caregiver issue. But especially when it comes to disease characteristics, if there’s a lot of disease burden and they’re not going to be able to wait for the authorization, the collection, and the manufacturing time window, there is a significant vein-to-vein time when it comes to CAR T-cell therapy in the autologous world, and that’s still being optimized. When they can’t wait, and they need to get on some therapy, that’s when, if they’re in the third-line setting, and bispecific T-cell engagers [BiTEs] are warranted, indicated, and covered, that’s definitely a viable solution. [It is] a very feasible solution, especially in the community where BiTE “off-the-shelf” therapies are more prevalent or available. I definitely agree with that; that’s something that needs to be done. I agree with Dr Lufti; if there’s a good response from that, and it’s a good disease-holding therapy, it could very well be a good bridge to CAR T. That’s a discussion that can be had once the disease is stabilized.

Ahmed: I agree with both [doctors]. I look at frailty, caregiver availability, patient preferences, and previous treatments.