Table 3.

Comparative analysis of CAR-T therapy and BiTEs therapy in MM treatment.

Features	CAR-T therapy	BiTEs therapy
Basis of design	Genetically modified T cells with CAR receptors	Engineered antibodies with dual specificity
Targeting mechanism	Directly targets tumor-associated antigens	Bridges T cells to cancer cells by simultaneously targeting CD3 on T cells and an antigen on cancer cells
Manufacturing complexity	High (requires cell extraction, genetic modification, and reinfusion)	Relatively low (manufactured as an off-the-shelf drug)
Treatment personalization	Highly personalized, using the patient’s own cells	Not personalized, can be used for any eligible patient
Therapy persistence ADA	Potential for long-term persistence in the bodyReduced risk of ADA (anti-drug antibodies) induction in fully human CAR-T therapies	Lacks long-term persistence; repeated dosing necessaryRepeated doses with high risk of inducing ADA
Side effect management	Requires careful monitoring and management of potential severe side effects	Generally manageable with standard care protocols
Administration	Complex, involving leukapheresis, lymphodepleting conditioning, and one time infusion	Simpler, administered directly without prior patient-specific preparation, but repeated administering
Applicability and accessibility	Limited by manufacturing time and capacity; not immediately available	Widely applicable and immediately available to patients
Activation of T cells	Regulate immune functions of host cells, inducing T cell expansion	Activate host T cells without inducing expansion
Immune system regulation	Modulate immune function of both converted and non-converted host immune cells	Limited capability; can only activate T cells directly engaged by the therapyBiTEs carry the risk of inducing T cell exhaustion
Antigen targeting	Target tumor antigens through engineered receptors, capable of broader immune system engagement	Direct targeting of tumor cells and activation of T cells through dual specificity
Immune escape	Lower risk of immune escape due to the ability to modulate broader immune responses	Higher risk of antigen-mediated immune escape due to reliance on a single target for activation
Cost	High initial cost due to the complexity of manufacturingPotentially reduced long-term healthcare costs due to durability	Potentially lower upfront costsMay increase over time with the need for continuous treatment
Efficacy and safety	CAR-T involves a single infusionHigh efficacy with the potential for durable remission, but associated with a risk of severe immune-related adverse events	Less effective, with a mild and transient responseRequire repeated infusionsSlower immune reconstitution with BiTEsRisk of worse infection outcomes

ADA: Anti-drug antibodies; BiTEs: Bispecific T cell engagers; CAR-T: Chimeric antigen receptor T; CD: Cluster of differentiation; MM: Multiple myeloma.