CAR-T and Bispecific White Paper

The two indications where the competition is most active are multiple myeloma (MM), a cancer of the plasma cells in bone marrow that primarily affects patients over 65, and diffuse large B-cell lymphoma (DLBCL), the most common and aggressive form of non-Hodgkin lymphoma. Other indications referenced include acute lymphoblastic leukemia (ALL), a fast-moving blood cancer; extensive-stage small cell lung cancer (ES-SCLC), typically diagnosed after the disease has spread; and EGFR-mutated non-small cell lung cancer (NSCLC), a genetically defined subset of the most common lung cancer type.

We set out to answer a specific set of questions:

• Has the migration from CAR-T to bispecifics held, accelerated, or reversed?
• Which brands are gaining ground, which are plateauing, and which are losing patients?
• Is the shift the same in MM as it is in DLBCL, or are the two markets behaving differently?
• As CAR-T supply stabilizes and indications expand, are referral patterns changing to match?
• Where do manufacturers still have room to defend, share or reopen growth?

These questions matter now because the market is at an inflection point.

CAR-T capacity constraints that defined the early launch years are easing, bispecific labels are broadening, and prescribing is moving out of academic medical centers and into community settings.

Decisions made in the next several quarters, on field deployment, medical engagement, and site-of-care strategy, will shape competitive positions for years.

We will continue to watch this closely because the Medicare population is the clearest early signal of where these classes are heading, and the trend lines are moving fast enough that a quarterly read is no longer sufficient.

Leveraging complete census-level access to monthly Medicare claims, CareSet analyzed data from October 2024 to February 2026 to uncover insights into CAR-T and Bispecific therapies, focusing on utilization, growth, referral networks, and opportunities in DLBCL, and MM.

Bispecific Therapies Are Outpacing CAR-T in Adoption

According to our data analysis from Q4 2024 to February 2026, while CAR-T remains a key treatment and continues to be recommended ahead of bispecific antibodies in 2025 guidelines, it faces perceived challenges related to supply chain and care delivery. At launch, CAR-T manufacturers struggled to meet demand; although supply has since stabilized, physicians still view high-acuity complications as a barrier to outpatient use. Meanwhile, bispecific therapies have expanded rapidly over the past 17 months, driven by “off-the-shelf” availability and expanding indications.

Adoption and Growth of Bispecific Therapies

The bispecific therapy market within the Medicare population has shown strong uptake from Q4 2024 through the end of 2025, followed by a slight decline in Q1 2026.

Though many of the brands have been approved for several years, they have continued to see steady
month-over-month growth in patient counts. (Please note, the graph shows a decline in the last two data points. This is not a negative inflection and is due to having a 2-week lag on monthly claims, so not all hospital and outpatient claims are adjudicated.)

Since October 2024, treated patient counts for bispecific therapies show the following trends:

• Johnson & Johnson’s TECVAYLI has led the other 13 bispecific therapies over the past 18 months, building on strong growth that began in spring 2023. As of December 2025, it maintained the highest volume with 1,009 Medicare beneficiaries, significantly ahead of the next therapy.
• Amgen’s IMDELLTRA, which received accelerated approval in May 2024, scaled rapidly. Following full FDA approval in November 2025, it became the second most utilized oncology bispecific.
• J&J’s RYBREVANT plateaued after rapid early uptake through mid-2025, with patient volumes declining notably in Q1 2026.
• J&J’s TALVEY, approved by the FDA in August 2023 for relapsed/refractory multiple myeloma, demonstrated a clear upward trajectory over most of the past 17-month period.

Overall, bispecific therapies have demonstrated a robust upward trajectory in both patient enrollment and
prescribing provider counts. These metrics underscore a deepening market penetration and broader clinical adoption facilitated by improved patient access.

CAR-T Cell Therapies Experienced Steady Declines

As seen in Figure 2, while CAR-T therapy volumes remained largely stable throughout 2025, a notable decline in Q1 2026 suggests a pivot in the market landscape.

Examining the patient counts of CAR-T therapies since October 2024 in Figure 2 reveals notable trends among key brands:

• Though seeing slight fluctuations, J&J’s CARVYKTI continued to lead in patient counts from Q4 2024 to March 2026 and then experienced a sharp decline in Q1 2026.
• BMS’s ABECMA patient volume surged starting in March 2025 and peaked in May 2025. Patient counts dropped back and eventually bottomed out in the spring of 2026.

• BMS’s BREYANZI remained one of the top-performing CAR-T therapies throughout 2025. Yet following the indication expansion in December 2025, its patient counts showed a clear and significant downward trend into the first quarter of 2026.

Analyzing Adoption and Market Dynamics of CAR-T and Bispecific
Therapies for DLBCL

CAR-T therapies displayed a more variable trend than bispecifics, and this trend is further supported by
patient-count-based evaluation of treatments across classes. The trends for five treatments, all indicated for DLBCL, three of which are CAR-T and two of which are bispecifics, are shown in Figure 3.

• Genmab’s EPKINLY and Genentech’s COLUMVI, both bispecific brands, have emerged as the leading therapies by patient volume in the DLBCL space.
• Conversely, all three analyzed CAR-T brands — Novartis’ KYMRIAH, BMS’s BREYANZI and Kite Pharma’s YESCARTA — show a steady decline in patient counts, continuing the trend previously identified in this analysis.
• BMS’s BREYANZI maintained the highest volume among CAR-T therapies.

Analyzing Multiple Myeloma Shifts from CAR-T to Bispecifics in
Trends

In Multiple Myeloma (MM), Figure 4 shows a similar trend. Note that the patient counts combine new patient starts and continuing patients. The MM sector demonstrated an even more aggressive dominance by bispecific antibodies, compared with the DLBCL market.

• J&J’s TECVAYLI, which received FDA approval in October 2022, has led the bispecific space, outperforming J&J’s TALVEY and Pfizer’s ELREXFIO, as well as CAR-T therapies BMS’ ABECMA and J&J’s CARVYKTI. It showed steady growth from October 2024 through spring 2025, peaking at 991 patients in April 2025.
• J&J’s TALVEY, the second most utilized therapy in the MM market, reported steady growth throughout 2025 and saw a notable increase toward year-end. Its utilization has been roughly double that of Pfizer’s ELREXFIO, with both therapies approved in August 2023.
• BMS’s ABECMA saw a brief utilization spike in spring 2025 before falling below reportable Medicare patient thresholds.

The overarching trend in the Medicare population revealed a massive divergence in utilization between bispecific antibodies and CAR-T therapies. While CAR-T therapies started the analysis period with a total monthly volume of around 200 patients in October 2024, they experienced a significant decline of 45% over the past 17 months.

In contrast, oncology-specific bispecific therapies demonstrated robust expansion with an increase of 35% by February 2026. This underscores that high-touch cellular therapies are increasingly being relegated to niche applications as more accessible, “off-the-shelf” bispecific alternatives dominate the therapeutic landscape.

We welcome the opportunity to meet and provide a detailed review of our findings — going beyond what is included in this free report. Whether you’re seeking insights into Line-of-Therapy trends at leading institutions or isibility into referral networks of AMC-community physicians.

Please contact us at ashish.patel@wordpress-1654971-6618904.cloudwaysapps.com or the contact form at www.wordpress-1654971-6618904.cloudwaysapps.com.