Comparing the Approved BCMA Bispecifics: Efficacy, Toxicity, and Treatment Burden

This segment provides a detailed comparison of the 3 FDA-approved BCMA bispecific antibodies: teclistamab, elranatamab, and linvoseltamab. Nooka summarizes the pivotal trials—MajesTEC-1 for teclistamab, MagnetisMM-3 for elranatamab, and LINKER-MM1 for linvoseltamab—and emphasizes that all 3 agents deliver remarkably consistent overall response rates in the 60–70% range, with linvoseltamab achieving the highest reported responses in its dataset.

The conversation then shifts to safety profiles, particularly cytokine release syndrome (CRS), infections, and cytopenias. Early teclistamab data demonstrated CRS in over 50% of patients, though primarily grade 1 events. Later agents show decreasing CRS incidence—approximately 40% with linvoseltamab—a trend the panel attributes to improved trial-era supportive care, prophylactic strategies, and more refined step-up dosing regimens. Infection rates have similarly declined across trials, aided by emerging consensus around IVIG replacement, antimicrobial prophylaxis, and vigilant monitoring.

A critical differentiator discussed is treatment frequency and burden. Unlike the earlier agents that required weekly dosing during extended periods, linvoseltamab was designed from the outset withless frequent administration, including earlier transitions to biweekly and then monthly schedules. The panel highlights this feature as potentially contributing not only to patient convenience but also to lower toxicity due to reduced cumulative immune activation. The segment concludes with the consensus that while all agents are effective, differences in dosing schedule, CRS incidence, and infection risk meaningfully shape bedside decision-making, particularly in community settings where treatment logistics matter deeply.