Oncology Pharmacy Virtual Office Hours Highlight Emerging Strategies for Implementing Bispecific Antibodies

This spring, ACCC hosted 2 virtual office hours sessions featuring oncology pharmacists with expertise in using bispecific antibodies (BsAbs), a promising class of therapies for hematologic malignancies and solid tumors. These peer-to-peer discussions brought together pharmacy leaders from academic and community settings to share practical insights, challenges, and strategies for implementing BsAb care models.

Participants included pharmacists whose institutions are actively administering BsAbs and those in the planning stages. Key themes captured during the sessions included patient monitoring strategies, balancing inpatient and outpatient administration, navigating operational barriers, and demystifying immune-related toxicity management.

Balancing Inpatient and Outpatient Monitoring

BsAbs represent a growing treatment option across oncology, but with their clinical benefits come risks—particularly cytokine release syndrome (CRS) and neurotoxicity. Patients require appropriate observation to monitor for these risks, and institutions are taking varied approaches based on their infrastructure and comfort level with remote symptom management.

Robert Mancini, PharmD, BCOP, FHOPA, oncology pharmacy program coordinator at St. Luke’s Cancer Institute, administers BsAbs primarily in the outpatient setting, but only for patients with reliable at-home support. “The biggest deciding factor on whether we’re going to administer in the outpatient setting is caregiver support,” he said. “If our patients do not have a reliable caregiver, we sometimes choose to put them in the hospital for the key step-up dosing.”

Kirollos S. Hanna, PharmD, BCPS, BCOP, FACCC, FAPO, director of pharmacy at Minnesota Oncology, administers BsAbs at outpatient infusion centers and partners with a local hospital to admit patients for the subsequent observation period. Minnesota Oncology aims to develop a service for remote monitoring from home rather than a hospital. “That was just a bit more complex for us, and the volume wasn’t there to roll that out [yet],” Hanna said.

At Levine Cancer Institute, a pilot program is testing at-home monitoring for patients with myeloma receiving BsAbs. Donald Moore, PharmD, BCPS, BCOP, DPLA, FCCP, clinical oncology pharmacy manager, hopes to cut down on the “in and out, back and forth to the hospital” currently associated with the treatment at his institution. Moore sees fully outpatient care as the future for BsAbs. “Eventually, we all should be able to provide these therapies without [the need for] the hospital,” Moore said. Hanna agreed, noting, “It’s just a matter of building up that infrastructure.”

Technology is a key part of that infrastructure. As a clinical pharmacy manager in the Division of Hematological Malignancies and Cellular Therapeutics at the University of Kansas Health System, Zahra Mahmoudjafari, PharmD, MBA, BCOP, FHOPA, shared that patients are discharged with thermometers, blood pressure cuffs, and pulse oximeters funded by a grant, but she notes that simpler tools may suffice. “One of the cardinal signs of CRS is fever,” she explained. “Maybe we’re going overboard unless you’re planning on treating grade 2 CRS as an outpatient.”

On the provider side, the experts emphasized being prepared to address questions and problems at any time. This includes efficient systems to route after-hours calls to the right providers and clear guidelines for handling emergencies that occur at home.

Misconceptions About CRS Management

CRS remains one of the most discussed safety concerns associated with BsAbs. However, the actual severity and manageability of CRS may be less daunting than perceived, especially compared to chimeric antigen receptor (CAR) T-cell therapy.

“There is this fear associated with cytokine release syndrome, which is justified in a sense,” said Mancini, “but you have to put it in context of these drugs.” When BsAbs first entered clinical practice, guidance was limited and often extrapolated from CAR T protocols. However, BsAb-associated CRS is typically milder (grade 1–2) and more predictable, thanks in part to step-up dosing and prophylactic steroids. Now, clinical evidence exists that can properly contextualize (and mitigate) understandable concerns.

Importantly, CRS in BsAbs tends to have a delayed onset—often over 24 hours posttreatment—giving providers a window to intervene if symptoms such as fever arise, even if the patient is being monitored at home. When the care team is educated and prepared, they are well-equipped to handle the adverse effects of BsAbs. “CRS can be very unfamiliar to a lot of people outside of our direct disciplines,” said Moore. “We need to continue to demystify BsAbs CRS compared to CAR T CRS.” He recommends the ACCC Blueprint for Successful Integration of Bispecific Antibodies as a resource to identify which members of the care team may benefit from this education.

Starting Small: Recommendations for Implementation

For institutions just beginning to implement BsAbs, the panelists advised a gradual, focused approach. At Minnesota Oncology, Hanna’s team started with one clinic and one single provider who volunteered to be a champion of the therapy. Mahmoudjafari recommends selecting a single BsAb that is aligned with institutional priorities. “You can do it patient-specific or disease state-specific,” she said. “Once you’ve onboarded the first one, the next ones become incrementally much easier.” Some institutions may prefer to start in the inpatient setting until protocols are well established. “Go overboard with your first one. Get comfortable with it. Once you have that experience, you can push for the outpatient setting,” said Mancini.

Finally, cross-disciplinary collaboration is critical. Dr. Moore emphasized that while pharmacists play a key role in BsAb implementation, success depends on shared ownership across the care team.

Providers can also lean on the experience of their peers who have already introduced these treatments to their institutions. ACCC has created written and recorded educational materials for BsAbs through close consultation and collaboration with our members. If you have specific questions for the pharmacy experts, members are invited to attend our next session of virtual office hours on July 23, 2025, from 11:00 AM–12:00 PM EDT.

Additional resources for cancer care teams can be found in the ACCC bispecific antibodies resource library and on the ACCC bispecific antibodies webpage. The ACCC Oncology Pharmacy BsAbs Office Hours is supported by Johnson & Johnson.