Are any bispecific antibodies FDA approved? So bispecific antibodies, they are very promising and I think they're going to really very much change the landscape of myeloma therapy. At the present moment, as you know, late to 2021, there's not a bispecific antibody that is yet FDA approved. But I think some are getting pretty close because they have very advanced data on phase one and phase two trials, for example, you know, teclistamab, tequetamab, to name a few. As of August 2023, three bispecific antibodies have been FDA approved. On October 25, 2022, the Food and Drug Administration granted accelerated approval to teclistamab, the first bispecific B-cell maturation antigen-directed CD3 T-cell engager, for adult patients with relapse or refractory multiple myeloma who have received at least four prior lines of therapy, including a proteasome inhibitor, an immunomodulatory agent, and an anti CD38 monoclonal antibody. On August 9, 2023, the Food and Drug Administration granted accelerated approval to talcuetamab, a bispecific antibody whose target is GPRC5D, for adults with relapse or refractory multiple myeloma who have received at least four prior lines of therapy, including a proteasome inhibitor, an immunomodulatory agent, and an anti CD38 monoclonal antibody. And on August 14, 2023, the Food and Drug Administration granted accelerated approval to l-rananamab, a bispecific BCMA-directed CD3 T-cell engager for adults with relapsed or refractory multiple myeloma who have received at least four prior lines of therapy, including a proteasome inhibitor, an immunomodulatory agent, and an anti CD38 monoclonal antibody. So at the moment, patients can access those therapies going through their myeloma referral center where they have clinical trials. There's a large number of clinical trials with bispecific antibodies throughout the United States and elsewhere. They are being explored primarily on those patients who have had therapies with a proteasome inhibitor like Velcade or Kyprolis, an immunomodulatory agent like Revlimid or Pomelis, and a CD38 monoclonal antibody like diuretumumab and isotuximab. However, as they proved to be safe and successful in that setting, there are several studies under investigation using those agents early on, so even for patients who are not refractory to all those agents, or even better, combining those bispecific antibodies with agents that we all have embraced as part of the myeloma, our myelomentarium. What does the clinical data for bispecific antibodies show? So bispecific antibodies are very exciting and we have over the last year to year and a half seen several publications and presentations on these. There are at least half a dozen of these in clinical development. All of them are shown at the maximally tolerated dose, or what we call the recommended phase two dose, to have response rates in about two-thirds of patients with complete remissions in about one-third of patients. What we lack right now is mature data on the durability of these responses. However, in literally all these experiences, there already are patients nearly two years or in some cases even longer on these, but what the average length of response is going to be is something that is unclear today, but I think that we may start seeing some data to answer that question. Who would be the right patient for a bispecific antibody? So once again, like with any modality of treatment, this has to be something that has to be individualized after discussion between a physician and their patient. The antibody drug conjugates are drugs that have had some toxicities, which are more in the myeloma area, ocular in nature, whereas bispecific antibodies have had toxicities more akin to car T cells, but at a more muted level. You have cytokine release syndrome, neurological toxicity, and both of them are off the shelf products. So they do have an advantage in being easily accessible, and especially in a patient who can't often wait the several weeks that it takes to get a car T cell, they both offer good treatment options, but I think you have to then decide which of these are more likely to benefit a patient with antibody drug conjugate that is currently licensed. On November 22, 2022, GSK announced the market withdrawal of BlendRep following the request of the FDA. This request was based on the previously announced outcome of the Dream 3 Phase 3 confirmatory trial, which did not meet the requirements of the FDA accelerated approval regulations. What we know is that it's about three to four months of progression-free survival for most patients, but those who respond, it's nearly out a year of disease control. With bispecifics, we don't know the data yet on the durability, but I think the decision on what to give is going to have to be made based on right now immature data.