How Do Bispecific Antibodies Work?

Bispecific antibodies are a type of immunotherapy used in the treatment of follicular lymphoma that does not respond to treatment (refractory), or has relapsed after two or more lines of other treatments. The FDA approved mosunetuzumab, the first and currently, the only drug in the bispecific antibodies class of drugs, in January 2023.

Follicular lymphoma is a cancer of the lymphatic system, a type of non-Hodgkin’s lymphoma (NHL). The lymphatic system is a part of the immune system and contains two types of white cells, T-cells and B-cells, that fight infection. Follicular lymphoma, also known as B-cell lymphoma, causes uncontrolled proliferation of abnormal B-cells.

Bispecific antibodies are humanized monoclonal antibodies of the immunoglobulin G1 (IgG1) isotype, directed against two different targets on the lymphocytes. Bispecific antibodies simultaneously identify and bind to two protein particles, CD20 on B-cells and CD3 on T-cells. This activates T-cells which release pro-inflammatory proteins (cytokines) and destroy B-cells that are marked by the bispecific antibodies.

Bispecific antibodies are infused intravenously to treat adult patients with follicular lymphoma that is refractory or has relapsed after two or more lines of systemic therapy.

Side effects of bispecific antibodies include the following:

• Decrease in lymphocytes
• Decrease in hemoglobin
• Decrease in white blood cells
• Decrease in neutrophil immune cells
• Decrease in platelets
• Decrease in phosphate levels
• Increase in blood glucose levels
• Decrease in magnesium
• Decrease in potassium
• Increase in aspartate aminotransferase (AST)
• Increase in alanine aminotransferase (ALT)
• Increase in gamma-glutamyl transferase (GGT)
• Increase in uric acid
• Cytokine release syndrome
• Fatigue
• Fever (pyrexia)
• Swelling (edema)
• Chills
• Rash
• Itching (pruritus)
• Dry skin
• Skin peeling (exfoliation)
• Headache
• Peripheral nerve damage (neuropathy)
• Dizziness
• Musculoskeletal pain
• Joint pain (arthralgia)
• Cough
• Shortness of breath (dyspnea)
• Nausea
• Diarrhea
• Abdominal pain
• Upper respiratory tract infection
• Urinary tract infection
• Insomnia

Information contained herein is not intended to cover all possible side effects, precautions, warnings, drug interactions, allergic reactions, or adverse effects. Check with your doctor or pharmacist to make sure these drugs do not cause any harm when you take them along with other medicines. Never stop taking your medication and never change your dose or frequency without consulting your doctor.

Generic and brand names of bispecific antibodies include:

• Lunsumio
• mosunetuzumab
• mosunetuzumab-axgb