How bispecific antibody treatment is expanding cancer treatment options for patients

Recent advances in bispecific antibody therapy are offering new hope to patients whose cancer has come back or has not responded to standard treatments. By helping the immune system recognise and attack cancer cells more effectively, this approach is creating additional treatment options at a stage where choices may otherwise be limited.

At GenesisCare, bispecific antibody treatment is delivered through specialist care pathways with Cambridge University Hospitals NHS Foundation Trust and other leading centres, supported by experienced multidisciplinary teams. For selected patients GenesisCare provide a complete ambulatory bispecific pathway, which allows patients to receive treatment and monitoring at GenesisCare while spending the time between treatments at home rather than staying in hospital overnight. Careful assessment, monitoring and personalised treatment planning help ensure each patient receives the most appropriate treatment for their individual situation.

At GenesisCare, bispecific antibody treatments are available for selected patients with:

●      Multiple myeloma

●       Lymphoma

●      Lung cancer

These treatments are typically used when cancer has come back after previous treatment (called relapsed disease) or has not responded to treatment as expected (called refractory disease). 

To understand bispecific antibody therapy, it helps to start with antibodies and how the immune system normally works.

Antibodies are proteins produced by the immune system that recognise and attach to specific targets, known as antigens. These targets may be found on viruses, bacteria or abnormal cells, including cancer cells. T cells are another important part of the immune system and play a central role in identifying and destroying abnormal cells.

Bispecific antibodies are specially engineered proteins that target cancer cells directly to help the immune system recognise and remove them.

Unlike personalised cellular therapies such as CAR T-cell therapy, bispecific antibody treatment does not involve collecting or genetically modifying a patient’s own cells. Because the treatment does not need to be individually manufactured, it can often be delivered more quickly while still providing a highly targeted immunotherapy approach.

At specialist treatment centres, experienced teams guide patients through every stage of treatment, ensuring the therapy is appropriate and aligned with their overall care plan.

Under normal conditions, T cells identify abnormal cells by recognising specific proteins called antigens on their surface. However, cancer cells can develop ways to avoid detection by hiding or altering these signals.

Bispecific antibody therapy is designed to bypass this problem by directly guiding immune cells towards cancer cells.

Bispecific antibodies are engineered with two separate binding domains. One domain recognises a specific protein on the cancer cell, while the other binds to a receptor on the T cell, most commonly a protein called CD3.

By binding to both cells simultaneously, the antibody helps activate the T cell directly against the cancer cell.

The specific targets used depend on the type of cancer being treated. For example:

• In multiple myeloma, different drugs target proteins called BCMA and GPRC5D
• In lymphoma, drugs target a protein called CD19

Once activated, the T cell releases substances that can damage and destroy the cancer cell. Activated immune cells can also recruit additional immune cells, strengthening the overall immune response.

Unlike CAR T-cell therapy which can create a long-lasting immune response, bispecific antibodies work while they are present in the bloodstream. As treatment continues, the antibodies keep directing T cells towards cancer cells, helping maintain an ongoing immune response over time.

Because bispecific antibodies are designed to target specific antigens, they offer a highly precise treatment approach. They can also be incorporated into a wider treatment strategy, either as a standalone therapy or in combination with other treatments, depending on the individual patient’s needs.

Bispecific antibody treatment is usually started using a step-up dosing approach. This means smaller doses are given at the beginning of treatment and gradually increased over the first few treatments until the full dose is reached.

This approach is used because bispecific antibody treatment directly activates the immune system, particularly when T cells first begin recognising and attacking cancer cells.

As part of this process, activated immune cells release inflammatory signalling proteins called cytokines. While cytokines help coordinate the immune response, they can also cause side effects such as fever, low blood pressure and flu-like symptoms, particularly during the first few doses.

Step-up dosing helps reduce the risk and severity of these side effects by allowing the immune system to adjust more gradually.

During this early phase, patients are monitored more closely, as side effects are more likely to occur at this stage. In many cases, these effects become less frequent or less severe as treatment continues.

Because bispecific antibody therapy is complex and highly specialised, it is important that it is delivered within a dedicated treatment programme.

Specialist treatment centres bring together haematology experts, oncology teams, specialist nurses and support staff who are experienced in delivering immunotherapy. These teams work within structured care pathways to ensure treatment is delivered safely and effectively.

Patients benefit from coordinated care, access to the latest therapies and ongoing support throughout their treatment journey.

By working with leading institutions and clinical networks, specialist centres are able to offer access to innovative treatments that may not be widely available elsewhere.

Bispecific antibody therapy may be an option for people whose cancer has returned or has not responded to previous treatments.

If you would like to understand whether this treatment could be suitable for you, speaking to a specialist team is an important first step.

By seeking expert advice, you can explore your options, understand the potential benefits and risks, and receive a personalised recommendation based on your individual circumstances.

Professor Karthik Ramasamy, MBBS, PhD, FRCP, FRCPath

Consultant Haematologist