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# Bispecific T-cell engagers

Antibodies with two arms: one grabs CD3 on the patient's T cells, the other a tumour antigen, so the T cell kills the cancer cell. Watch for CRS and ICANS.

Updated Nov 1, 2026

## What they are

Engineered antibodies that bind two different targets at once. One arm binds CD3 on T cells; the other binds a tumour antigen, for example CD19 (blinatumomab, in B-cell leukaemia) or BCMA (teclistamab, in multiple myeloma). Unlike CAR T cells they are ready-made («off the shelf»), but they need repeated doses.

## Mechanism of action

By bridging a T cell and a tumour cell the drug forms an artificial immune synapse, independent of MHC. The T cell releases perforin and granzymes and kills the target, then proliferates and releases cytokines. Doses are increased in steps (step-up dosing) to blunt the first wave of cytokine release.

Target: CD3 on T cells plus a tumour antigen (for example BCMA or CD19)

## Key points

- Boxed warnings: cytokine release syndrome and neurotoxicity (ICANS), most often after the first doses.
- Step-up doses are given with premedication and close monitoring, often in hospital.
- Serious infections are common; signs of infection are reported promptly.
- Blinatumomab (CD19 × CD3) was the first; it has its own page in the monoclonal antibody group.

## Drugs in this class

- [**Teclistamab** Bispecific antibody that links CD3 on T cells to BCMA on myeloma cells; for relapsed multiple myeloma. Boxed risks… BCMA (B-cell maturation antigen, TNFRSF17) on myeloma cells, and CD3 on T cells](https://durgical.com/en/pharmacology/teclistamab/)

## Others in the class

- elranatamab
- talquetamab
- epcoritamab
- glofitamab
- mosunetuzumab
- tarlatamab

## Test yourself

Think of the answer, then tap the question to see it.

## Which T-cell molecule does almost every bispecific T-cell engager bind?

CD3, part of the T-cell receptor complex.

## Why are the first doses of a bispecific given in steps?

To reduce the risk and severity of cytokine release syndrome.

## What is one practical advantage of a bispecific over a CAR T-cell product?

It is ready-made and does not require collecting and engineering the patient's own cells.

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Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: [Teclistamab-cqyv - NCI](https://www.cancer.gov/about-cancer/treatment/drugs/teclistamab-cqyv) (National Cancer Institute, 2026); [Teclistamab-cqyv Injection: MedlinePlus Drug Information](https://medlineplus.gov/druginfo/meds/a622076.html) (MedlinePlus (U.S. National Library of Medicine), 2026); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=L01FX) (WHO Collaborating Centre for Drug Statistics Methodology, 2026).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/pharmacology/classes/bispecific-t-cell-engagers/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/classes/bispecific-t-cell-engagers/