Bispecifics: What You Need to Know

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.

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.

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

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.

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).

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.