Episode 383: Pharmacology 101: Bispecific Antibodies

“I think that this is an area that is exploding. Working with drug development, I see new agents all the time, with unique targets I’ve never heard about, with targets I have heard about used in a different way. So, I really think we’re going to see more and more bispecifics. A lot of these drugs are used second line, third line, fourth line. I would not be surprised if they moved up in treatment, especially as we learn safer ways to give these drugs,” ONS member Moe Schwartz, PharmD, BCOP, FHOP, professor of pharmacy practice at the James L. Winkle College of Pharmacy at the University of Cincinnati, OH, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS^®, manager of oncology nursing practice at ONS, during a conversation about bispecific antibodies. 

Music Credit: “Fireflies and Stardust” by Kevin MacLeod

Licensed under Creative Commons by Attribution 3.0 

Earn 0.5 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by October 3, 2026. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation.

Learning outcome: Learner will report an increase in knowledge related to the use of bispecific antibodies in the treatment of cancer.

Episode Notes 

• Complete this evaluation for free NCPD.
• ONS Podcast™ episodes:
  • Pharmacology 101 series
  • Episode 275: Bispecific Monoclonal Antibodies in Hematologic Cancers and Solid Tumors
  • Episode 261: CAR T-Cell Therapy for Hematologic Malignancies Requires Education and Navigation
  • Episode 176: Oncologic Emergencies: Cytokine Release Syndrome
• ONS Voice articles:
  • An Oncology Nurse’s Guide to Bispecific Antibodies
  • Bispecific Antibodies
  • Cross-Discipline Cancer Care
• ONS Voice oncology drug reference sheets:
  • Amivantamab-Vmjw
  • Blinatumomab
  • Epcoritamab-Bysp
  • Glofitamab-Gxbm
  • Mosunetuzumab-Axgb
  • Tebentafusp-Tebn
  • Teclistamab-Cqyv
• ONS book: Guide to Cancer Immunotherapy (second edition)
• ONS course: ONS/ONCC^® Chemotherapy Immunotherapy Certificate™
• Clinical Journal of Oncology Nursing article: Optimizing Transitions of Care in Multiple Myeloma Immunotherapy: Nurse Roles
• Other ONS resources:
  • Bispecific Antibodies Video
  • Bispecifics Huddle Card
  • Cytokine Release Syndrome Huddle Card
  • Immune Effector Cell–Associated Neurotoxicity Syndrome Huddle Card
• DailyMed homepage
• Hematology/Oncology Pharmacy Association late-breaking news article: The Emerging Use of Bispecific Antibodies with Chemotherapy in Diffuse Large B-Cell Lymphoma

To discuss the information in this episode with other oncology nurses, visit the ONS communities. 

To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library.

To provide feedback or otherwise reach ONS about the podcast, email [e-mail].

Highlights From This Episode

“It was 2014 that most of us think of as the beginning of bispecifics in cancer, and that was with approval of blinatumomab. That was granted accelerated approval for the treatment of patients with Philadelphia chromosome–negative relapsed or refractory B-cell precursor acute lymphoblastic leukemia. It is a bispecific that targets CD19-expressing tumor cells and CD3 on T cells. It’s the original bispecific T-cell engager and is often called a ‘BiTE.’” TS 2:11

“The term ‘bispecific’ means that this is an artificial protein that’s developed to hit two different antigens simultaneously. They can be two different epitopes on the same antigen. They can be an antigen on a cancer cell and CD3 on a T cell that kind of recruits the T cell to the cancer. So, there are different types [of bispecific antibodies]. The subtype that we often talk about are bispecific T-cell engagers, which are those bispecifics that do target the T cell. And currently, the target on the T cell that’s utilized is the CD3 molecule. That’s not the only one that will be used in the future because there’s a lot of work being done on other types of T-cell engagers.” TS 4:21

“The targets for lymphoma are CD20. Those are bispecific T-cell engagers that hit CD20 on the lymphoma cell, as well as CD3 on a T cell. ... In myeloma, we have two different targets that have been utilized. One is BCMA or B-cell maturation antigen. That sits on the surface of myeloma cells and on some healthy B cells. ... There’s also a target used in myeloma that’s called GPRC5D, which stands for G protein–coupled receptor, class C, group 5, member D. ... In small cell lung cancer, there’s delta-like ligand 3 (DLL3); it’s part of the NOTCH pathway. ... And then this year, we’ve had a couple agents come out that target HER2.” TS 6:52

“[Toxicities] are very dependent on what your target is. ... The bispecific T-cell engager that’s used in myeloma that targets the GPRC5D is also expressed on tissues that produce hard keratin like hair follicles and actually, within the tongue. So the toxicities that we see with that agent are something you wouldn’t expect to see if you were using a myeloma agent. You see nail and skin issues. You see taste problems. So it’s very specific about the target, which says to me, that every time a new one of these agents comes out, I have to learn about the target that helps me learn about the toxicity. I find that fascinating and really appreciate that.” TS 16:19

“Cytokine release syndrome has been one of the areas that drug development has really focused on to see how they can help mitigate the severity [of it]. ... [One of] the strategies that has been incorporated and studied in clinical trials is the step-up dosing scheme. [It’s] where you give initial small doses and over time, increase the dose to the dose you’re going to continue with. Usually, monitoring in the hospital is required by the FDA approval for anywhere from 28–48 hours for the first couple of doses. And that’s a real common strategy that you’ll see. Premedication with H₂ blockers, H₁ blockers, sometimes steroids. These are also things that are incorporated within the approvals of these drugs and are important to look at.” TS 20:53