Expanding Access to Bispecific Antibodies in Community Cancer Care

As rapid advancements in immuno-oncology have led to exciting anti-cancer treatments and therapies, bispecific antibodies are hailed as an emerging class of novel immunotherapy agents with tremendous treatment potential. More than 50 bispecific antibodies are currently in clinical trials, yet barriers, such as serious treatment-related toxicities and other practical considerations, have limited its widespread use, particularly in the community-based setting. 

To expand the multidisciplinary cancer care teams’ utilization of this groundbreaking science and to optimize care for patients being treated with bispecific antibodies, the Association of Community Cancer Centers (ACCC) developed an educational initiative—“Best Practices in Expanding Access to Bispecific Antibodies and Adverse Event Management”—in partnership with the Society for Immunotherapy of Cancer (SITC). This project is also sponsored by Johnson & Johnson Healthcare Systems, Inc. 

Through a two-part series of focus groups and a joint ACCC and SITC “Expanding Community Access to Cell Therapy” workshop that was planned in conjunction with SITC’s annual meeting this fall, the initiative will explore early identification and management of adverse events that are common in patients being treated with bispecific antibodies. The project will focus on cytokine release syndrome, as well as it will examine practical solutions and best practices for transitioning patients to the community from the academic practice setting. 

Post-workshop, ACCC will release a whitepaper that will highlight key findings and recommendations cancer programs and practices can implement to create institutional protocols, pathways, and workflows to minimize and manage adverse events that are common with bispecific antibodies and to improve care coordination.  

This work will extrapolate from ACCC’s 2020 bispecific antibodies education project that sought to prepare community oncology providers for use of bispecific antibodies by identifying barriers to awareness, preparedness, and implementation. Srinivas Devarakonda, MD, associate professor in the Division of Hematology at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute at The Ohio State University and Advisory Committee member of ACCC’s 2020 bispecific antibodies project described, “Physicians, oncologists, pathologists, pharmacists, nurses, and multidisciplinary providers from various backgrounds—we did our homework. We asked what are the problems and areas we find difficult when treating a patient with acute lymphocytic leukemia with bispecific antibodies in a community hospital? A survey was created to determine the comfort level of these teams, basically a background check into situational factors to determine where we stand.”

Preliminary research and findings from ACCC’s 2020 survey on bispecific antibodies revealed common challenges community-based providers experienced. Of the 129 total survey respondents, identified challenges included transitioning patients from the inpatient to outpatient setting (41%), managing patients in remote areas (33%), securing insurance coverage (28%), managing side effects (27%), assisting patients with treatment-related costs (24%), and lacking in-house expertise with the drug class (22%).

As Dr. Devarakonda explains, “There is an inpatient to outpatient transition that must be very meticulous, so as not to miss any days of treatment. And in that, it takes a village…because you need insurance approvals and coordination with the infusion agency, nurses, local pharmacy, and local facility that would be comfortable managing the patient’s side effects if something were to happen.” Thus, improvements in communication and coordination across the continuum of care of is essential. 

With more bispecific antibodies progressing through clinical trials this year, their use in community cancer care is expected to increase as their indications expand to include more diseases that are routinely treated in outpatient settings (e.g., myeloma and solid tumors). Therefore, the time is now to explore practical solutions and best practices for bispecific antibodies, which will lay the groundwork for implementation of these complex treatments into the community.