A new study examining the implementation of bispecific antibodies (BsAbs) in community cancer centers has uncovered significant challenges and misconceptions among healthcare providers, highlighting the need for improved education and infrastructure development.
Widespread Misconceptions and Implementation Barriers
The collaborative research, conducted by the Association of Community Cancer Centers (ACCC), revealed persistent myths about BsAb utilization and safety profiles among pharmacists, physicians, and other healthcare professionals. Through focus group discussions with multidisciplinary teams, researchers identified several key implementation challenges.
"There was a lot of different types of myths and misconceptions still out there regarding BsAbs; how they're supposed to be utilized, what you need to utilize them, as well as their adverse events and adverse event management," explains Donald Moore, PharmD, BCPS, BCOP, DPLA, FCCP, the study's lead investigator.
Safety Monitoring and Infrastructure Requirements
A primary concern centers around the management of cytokine release syndrome (CRS) and neurotoxicity associated with BsAb therapy. The requirement for step-up dosing and hospitalization monitoring has created significant operational challenges for community centers.
Many facilities lack the necessary infrastructure for patient monitoring, particularly in remote settings. This limitation often necessitates partnerships with larger medical centers, adding complexity to patient care coordination.
Experience and Volume Challenges
Current BsAb indications primarily focus on niche populations, including:
- Heavily pre-treated lymphomas
- Advanced multiple myeloma
- Third-line treatment for small cell lung cancer
The specialized nature of these indications means smaller centers often lack sufficient patient volume to build substantial experience with BsAb administration. However, this situation is expected to evolve as BsAb approvals expand across different tumor types and earlier treatment lines.
Addressing Knowledge Gaps
A significant finding revealed that many healthcare providers incorrectly equate BsAb-related CRS with that of CAR T-cell therapy. This misconception extends to the timing and severity of CRS occurrence, particularly during maintenance dosing phases.
"Cross-organizational coordination and education can be beneficial in addressing the concerns regarding the lack of familiarity, as well as understanding how to manage adverse events," Moore emphasizes.
Implementation Strategy Recommendations
For community cancer centers considering BsAb implementation, experts recommend:
- Starting with 1-2 BsAbs that best match institutional capacity
- Ensuring sustainable and financially viable practice models
- Establishing clear protocols for obtaining insurance pre-authorizations
- Developing partnerships with larger centers when necessary
Future Research Needs
While clinical trials and real-world evidence from academic centers have demonstrated BsAb safety and efficacy, there remains a critical need for operational data from community settings. Documentation of implementation experiences from community cancer centers will be crucial in helping similar facilities successfully adopt these therapies.
