Diagnosis and management of bispecific T cell–engaging antibody toxicity: A primer for emergency physicians

Abstract

Background

T-cell-engaging bispecific antibodies (BsAbs) are a newer type of immunotherapy designed to boost T-cell cytotoxicity. They are increasingly used in cancer treatment, with drugs currently being tested and authorized for treating both liquid and solid tumors. It’s becoming more likely that emergency physicians and other acute care practitioners will treat patients experiencing adverse events related to bispecific antibodies, as these drugs are regularly given in the outpatient setting. Currently, BsAb-associated side effects are not routinely taught to Emergency Medicine residents, and a paucity of literature exists to guide currently practicing Emergency Medicine physicians and other acute care practitioners about these medications.

Objective of the review

This review was written by emergency medicine physicians in collaboration with oncologists who routinely administer BsAbs to provide guidelines and an overview on diagnosis, treatment, and management strategies for adverse events related to bispecific antibodies.

Discussion

Side effects related to BsAbs require a multidisciplinary treatment approach ideally with oncologists notified early when an adverse event is suspected. Symptom presentation is subtle with BsAb toxicity and the main adverse events to consider working up are cytokine release syndrome, immune effector cell neurotoxicity, and infection. The article also discusses unique side effects specific to FDA-approved drugs to treat leukemia, multiple myeloma, lymphoma, lung cancer, and melanoma given that this drug class has heterogeneous receptor-specific side effects.