Access to Oncology Care: Bispecific Antibody Administration in Community Practices

J Clin Pathways. 2025;11(2):26-27.

The development of bispecific antibody (BsAb) treatments has revolutionized cancer care by addressing drug resis­tance and improving efficacy and safety. BsAbs represent a new therapeutic approach, particularly for relapsed/refractory he­matologic malignancies.¹ Unfortunately, BsAbs are associated with adverse effects such as cytopenias, diarrhea, transaminitis, tumor lysis syndrome, cytokine release syndrome (CRS), im­mune effector cell-associated neurotoxicity syndrome (ICANS), and tumor flare, which can disrupt treatment administration.^1,2 Studies of treatment-related adverse events for BsAbs demon­strate that the prevalence of infection, neutropenia, CRS, and ICANS is 35%, 31%, 45%, and 12%, respectively.

Payers are becoming more active in managing the “place of ser­vice” for treatment administration. Generally, payers will drive the site of administration away from institutional outpatient departments to more cost-efficient office or home care settings. Thus, care coordination is of the utmost importance to man­age the potential adverse effects of BsAbs.³ To ensure consistent care coordination, cancer centers need to establish clear work­flows for managing adverse events, particularly when deter­mining hospital admission vs outpatient care and during-care transitions. Key operational considerations include implement­ing policies and procedures for risk evaluation and mitigation strategies (REMS), utilizing order sets and acute care plans, and providing ongoing training and education to keep providers in­formed of the latest information about BsAbs. Administrators, hospitalists, physicians, nurses, pharmacists, financial advo­cates, and manufacturer medical science liaisons all play a role in capacity building for cancer centers.³

To facilitate practice preparedness, readiness guides were de­veloped by McKesson and the Association of Cancer Care Centers (ACCC). McKesson’s Introducing Bispecific Antibody Therapy into Your Practices is characterized as a “playbook” comprising insights based on lessons learned and best prac­tices from clinics that have successfully launched BsAb infu­sions in the office setting. The playbook provides providers and practices with an introduction to BsAbs and outlines ad­ministrative and operational frameworks addressing the com­plexities of BsAb administration, including patient safety, financial recovery, and operational workflows. Administra­tive preparedness includes consideration of key partnerships with hospitals and other organizations to access necessary therapeutic resources for managing adverse reactions. This playbook is positioned as an introduction to BsAb therapy administration and is recommended for use in conjunction with additional resources.⁴

The ACCC provides a Best Practices in Expanding Access to Bispecific Antibodies and Adverse Event Management issue brief, which outlines barriers and challenges related to the adminis­tration of BsAB in the office setting. The brief addresses issues regarding treatment setting, potential adverse effects, coordi­nating referrals, and the provision of follow-up care. Similar to McKesson’s resource, the ACCC developed the Bispecific Antibodies Checklist for Community Providers to help cancer prac­tices and programs adopt the use of BsAb therapies to treat cancer in the office setting. Included in this checklist are steps for administration when referring to academic centers or ad­ministering BsAbs in the office, and steps for patient care. The ACCC tools were sponsored by Janssen Oncology.⁵

The development of BsAb treatments has significantly ad­vanced cancer care by improving efficacy and addressing drug resistance. However, because BsAbs are associated with notable adverse effects, it is crucial to administer careful management to ensure treatment continuity. As payers increasingly shift treat­ment administration away from institutional settings to more cost-effective locations, such as offices or homes, care coordina­tion is critical. Cancer centers must establish clear workflows, risk mitigation strategies, and ongoing provider education to manage adverse events effectively.

These considerations and additional resources developed by McKesson and ACCC provide essential frameworks for implementing BsAb therapies in community oncology settings, addressing operational, financial, and clinical challenges to en­hance patient care.