Purpose
Novel bispecific therapies across multiple oncology indications are limited to implementation at academic centers within metropolitan areas. There are currently over 220 oncology focused bispecific antibodies being investigated in clinical trials and the momentum continues to grow. There is a significant need to provide access to bispecifics in the community by building out logistics and infrastructure in the community and alleviate both provider and patient burden.
Methods
Bispecific therapies present unique challenges in community oncology, particularly management for cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). Initiation of bispecifics or continuation therapy from tertiary centers, require infrastructure. In Salem, OR, an outpatient bispecific program was developed and implemented to increase access to novel therapies. At Oregon Oncology Specialists, a practice lead implemented the following: bispecific toxicity training with multidisciplinary specialty groups; coordination of inpatient/outpatient pharmacy and nursing staff; continuing education module; patient education including monitoring materials (kits); Epic modifications and Risk Evaluation and Mitigation Strategies (REMS) program implementation.
Results
Implementation of the program provided structured communication pathways, support to health systems involved in the management of bispecific-treated patients, and education for staff and patients. The program supports patients in a robust way through clinic and remote monitoring via epic reporting. Two patients are currently in remission after failing 3+ lines of therapy. The continuation program is active allowing for transfers from tertiary centers, alleviating the need for travel and strain for chair/bed access.
Conclusion
It is imperative for community oncology practices to begin to develop bispecific therapy programs to increase access to life saving treatments such as bispecific immunotherapy. The sheer volume of novel therapies in the pipeline illustrate the oncology community’s need to initiate therapy independently, when possible, and continue management with tertiary centers to provide care for more complex and logistically challenging therapies.