Part 1: Safe Administration of Bispecific Antibodies in the Community Oncology Setting
Key Points
- While community oncologists have gained familiarity with bispecific antibodies, establishing best practices for safe administration of these therapies in the outpatient setting remains a critical need.
- Strategies such as step-up dosing and intravenous hydration may help mitigate cytokine release syndrome (CRS).
- Outpatient treatment may benefit patients who face challenges traveling to academic centers due to age-related concerns, comorbidities, and a lack of social support.
Bispecific antibodies have become more widely used in the community oncology setting. However, administering bispecifics safely remains a critical need, especially as more practices consider outpatient treatment. Community oncologist Raji Shameem, MD, of Orlando Health, spoke with Loretta Nastoupil, MD, of CommonSpirit Health, about these toxicities and how to reduce their burden.
Navigating Bispecific Antibody-Related Toxicities
A major focus of this discussion is the development of systematic strategies to manage CRS and neurotoxicity. Approaches such as step-up dosing, intravenous hydration, and consideration of prophylactic tocilizumab may help lessen these two serious side effects, Dr. Nastoupil said.
“These are all things, if we can come together as a community, to identify what our best practice is so that we can safely do this treatment outpatient,” she said. “I think it will open the door to many more community sites being able to do this.”
Epcoritamab provides an example of how treatment approaches have evolved. The therapy does not mandate inpatient monitoring after the first full dose, Dr. Shameem explained, and prospective studies have evaluated strategies to reduce CRS, including adding an additional step-up dose, particularly in follicular lymphoma. Furthermore, administering 1 L of intravenous fluids before the first dose has been explored to mitigate toxicity.
Outpatient administration can be valuable for patients who prefer to receive treatment closer to home. Older adults, patients with comorbidities, and those with limited social support may face significant challenges traveling to academic centers. However, because CRS can occur 6 to 12 hours after infusion—when patients are already home—community practices must have clear monitoring and communication strategies to ensure patients recognize symptoms and know when and how to contact their care team, Dr. Nastoupil said.