What You Need to Know

How Do Bi-specifics Work?

• Comprised of two different antibodies (“bi”) joined together, each with a specific receptor target.
• One target is on the cancer cell and the other target is on your T-cells, which are a part of the immune system, naturally found in the body.
• When both targets are bound by the respective antibodies of the drug, the body’s T-cells are activated, which results in the death of the cancer cell.

How Are Bi-specifics Given?

• Either via IV or subcutaneous as an injection.
• Start with a small dose and increase the dose with each treatment. A step-up dosing schedule is when you receive smaller “step-up” doses of the medication over several days to weeks.
• Given either for a set number of doses or continuously, depending on the type of cancer and the bi-specific being used.

Most Serious Toxicities

• Short Term:
    – Cytokine Release Syndrome (CRS)
    – Immune Effector Cell Associated Neurotoxicity Syndrome (ICANS)
• Longer Term:
    – Infection
• See handouts for more information on monitoring and management of these toxicities.

Most Common Toxicities

For Multiple Myeloma:

• Infections: We will give you prescriptions for Acyclovir and Bactrim to prevent shingles and a type of pneumonia while on treatment.
• Liver toxicity: We will watch your liver function tests closely.
• Injection site reactions: Apply a cold compress as needed for symptom relief. Over the counter acetaminophen/ibuprofen for pain and antihistamines for irritation/itching as needed.
• Less common: GI complications (constipation, nausea, diarrhea) fatigue, headache, joint aches, cough.

For Lymphoma:

• Infections: We will give you prescriptions for Acyclovir to prevent shingles and Bactrim to prevent a type of pneumonia while on treatment.
• Muscle pains, joint aches.
• Injection site reaction—Apply a cold compress as needed for symptom relief. Over the counter acetaminophen/ibuprofen for pain and antihistamines for irritation/itching as needed.
• GI complications (constipation, nausea, diarrhea).
• Liver toxicity: We will watch your liver function test (blood work) closely.
• Rash.
• Low blood counts (neutropenia, anemia, thrombocytopenia).

Requirements for Treatment:

• Patients must stay within 30 minutes of the Scarborough clinic for the first 48 hours after each treatment for the first 4-6 treatments based on the drug.
• Patients must have a caregiver (family or friend) present 24 hours a day until 72 hours after each dose for the first 4-6 treatments.
• Patients who are a candidate for bispecific antibody therapy will need to transfer their care to our Scarborough clinic while receiving treatment.