In an interview with Pharmacy Times®, Sundar Jagannath, MD, MBBS, professor of medicine—hematology and oncology at Mount Sinai Health System, emphasizes the pivotal role pharmacists play in the safe and effective administration of linvoseltamab (Lynozyfic; Regeneron), a BCMA-CD3 bispecific antibody approved by the FDA for the treatment of multiple myeloma.
Jagannath explains that, due to its fully human design, linvoseltamab poses fewer immediate infusion reactions than older therapies like rituximab (Rituxan; Genentech), though cytokine release syndrome (CRS) remains a key consideration. Pharmacists are instrumental in setting up order sets, releasing pre-ordered therapies like tocilizumab and steroids, and coordinating with clinical teams in real time. Jagannath affirms that pharmacists are no longer peripheral but essential members of the oncology care team.
Pharmacy Times: Given linvoseltamab’s unique bispecific mechanism targeting BCMA and CD3, what should pharmacists know about its immunologic profile and the potential for cytokine release syndrome (CRS) and other adverse events?
Key Takeaways
- Linvoseltamab’s fully human design minimizes immediate infusion reactions, but pharmacists remain essential in managing delayed CRS using real-time order systems and pre-prepared treatments.
- As studies explore linvoseltamab earlier in the treatment pathway—including as an alternative to transplant—its clinical utility continues to grow.
- Pharmacists are now frontline contributors to cancer care, playing a vital role in immunotherapy management, treatment planning, and multidisciplinary coordination.
Sundar Jagannath, MD, MBBS: From the pharmacist’s perspective, once administered, nurses typically monitor for infusion reactions. The good news is that linvoseltamab is a fully human antibody, unlike rituximab, which often causes immediate infusion reactions. You’re not going to get a rituximab-type response. That makes things easier for pharmacists. CRS doesn’t happen immediately—it’s more delayed, occurring during the post-infusion observation. Nurses monitor, and if symptoms appear, pharmacists release pre-ordered medications like steroids or tocilizumab. With electronic systems like EPIC, pharmacists are critical in building the order sets and ensuring timely administration. Physicians like me depend on pharmacists to get the orders right. In the past, the pharmacist’s role was limited to dispensing. Now, they are key clinical partners in managing advanced immunotherapies and their side effects.
Pharmacy Times: With ongoing studies evaluating linvoseltamab in earlier lines of therapy and in combination regimens, how do you envision its role evolving in the multiple myeloma treatment landscape?
Jagannath: Patients entering the LINKER-MM1 trial had failed at least 3 prior lines and were progressing despite exposure to the key drug classes. Still, we saw a 70% response rate—remarkable by any standard. Complete response rates were also strong, and the durability of those responses was meaningful. So if a drug is that effective and well tolerated in late-line settings, its future use is likely to shift earlier. There’s a study called DETERMINATION 2 from Dana-Farber (Paul Richardson’s group), where linvoseltamab is being tested in patients who did not achieve MRD negativity after induction. They’re comparing it to autologous transplant. That shows a high level of confidence in linvoseltamab. I believe myeloma is curable—we just need a definition for what "cure" means. I define it as achieving and maintaining CR and MRD negativity for 5 years. With agents like cilta-cel (Carvykti; Johnson & Johnson) and now linvoseltamab, we’re moving in that direction. If we can use these drugs to achieve and maintain MRD-negative status, more myeloma patients will be cured.
Pharmacy Times: Is there anything else that you would like to add?
Jagannath: This is for pharmacists: you are now an integral part of treatment, not ancillary. You're essential in designing orders, managing CRS, releasing tocilizumab (Actemra; Genentech), understanding ICANS, and helping nurses navigate patient care. Even if you're in a different room or role, you're receiving immediate feedback and are part of the clinical decision-making process. Hospital pharmacists have moved far beyond just dispensing—they’re advancing cancer care. Kudos to pharmacists. I depend on them. They’ve become indispensable in delivering safe, sophisticated therapies like linvoseltamab.
