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Optimizing Bispecific Antibody Therapy With Linvoseltamab
Shaji Kumar, MD, Mayo Clinic, highlights linvoseltamab’s dosing regimen, adverse effect profile, and management strategies. He speaks in particular about cytokine release syndrome, which although common, is typically mild and of short duration, and of proactive prophylaxis to mitigate the risk of severe infection.
The bispecific antibody linvoseltamab introduces a patient-centric advancement, with its response-adapted dosing regimen, a flexible approach that aims to reduce the treatment burden for patients while maintaining high efficacy, representing a significant step forward in managing cancer therapy.
Unlike other regimens that might require a week-long commitment at a facility, linvoseltamab’s administration can be more convenient for patients who cannot stay away from home for extended periods. A key feature of its labeled use is the ability to reduce dosing frequency for patients who achieve a very good partial response or better, to once every 2 or 4 weeks. Such areduction in frequency can lessen the burden on patients, which can lead to a significant improvement in quality of life. Although clinicians sometimes adapt schedules for other bispecific antibodies based on experience, having this guidance incorporated directly into linvoseltamab's label is a major advantage.
Like other therapies in its class, linvoseltamab is associated with adverse effects (AEs), primarily cytokine release syndrome (CRS) and infections.
- CRS: Although CRS occurred in 46% of patients in the LINKER-MM1 trial (NCT03761108), it is a manageable and predictable AE. Most cases are mild (grade 1-2), temporary, and can be handled with symptomatic care. Severe (grade 3-4) CRS is uncommon, affecting less than 2% of patients in many studies. The manageable nature of CRS with bispecific antibodies is leading to more treatments being administered in outpatient settings.
- Infections: Infections are a more serious concern, reported in 74% of LINKER-MM1 patients, with 36% experiencing grade 3 or 4 infections. The cumulative risk for severe infections with bispecific antibodies can be around 30% over time.
A critical observation is that infection risk may be related to the therapy intensity. The practice of response-adapted de-escalation, combined with effective antibiotic prophylaxis and the use of intravenous immunoglobulin, has become a key strategy to mitigate infection risk. By optimizing treatment protocols in this way, clinicians can better balance potent efficacy with long-term patient safety.
