A recently published qualitative analysis in the Journal of the Advanced Practitioner in Oncology highlighted how community practices are adapting to integrate bispecific antibodies safely and effectively into their treatment paradigms, emphasizing that the successful transition of bispecific antibody therapy into non-academic environments depends on well-defined communication networks, collaborative partnerships with local hospitals, and deliberate investment in staff and patient education.1
“Gaps [exist] between community and academic practices, and we’re seeing more of the advanced therapies being offered at academic centers, but we know the majority of patients are treated in the community. They’re not getting access to these novel [agents], which we’ve seen amazing outcomes with,” Donna Catamero, ANP-BC, OCN, CCRC, said.
In interviews with OncLive® at the 22nd Annual International Myeloma Society (IMS) Meeting and Exposition, Yi Lin, MD, PhD, a hematologist and cellular therapist at Mayo Clinic in Rochester, Minnesota, and Catamero, associate director of Myeloma Research at Icahn School of Medicine at Mount Sinai Hospital in New York, New York, discussed key considerations surrounding the use of bispecific antibody therapy in community settings, including the development of CRS management protocols, staff education, and patient support systems.
Why is expanding the use of T-cell directed therapies beyond academic centers critical to improving access and outcomes for patients with myeloma?
Currently, 3 bispecific antibodies—teclistamab-cqyv (Tecvayli), elranatamab-bcmm (Elrexfio), and talquetamab-tgvs (Talvey)—are approved by the FDA within multiple myeloma,2 along with 2 CAR T-cell therapies—ciltacabtagene autoleucel (Carvykti) and idecabtagene vicleucel (Abecma).
“These [T-cell directed therapies] are also being studied in earlier-line settings, so more and more patients could qualify to get these treatments, and many centers are starting to say there [are] not enough hospital beds to [support] them,” Lin explained. “We’re also learning, both with the [evolving] product profiles becoming safer and [through experience in] how to manage things safely, that a lot of this management could be amenable to outpatient practice. [There is] a need to shift our [treatment] pathways so that we can serve more patients.”
Findings from the qualitative analysis demonstrated that community oncology practices face several logistical and operational challenges when implementing immunotherapy workflows.1 Developing a coordinated workflow plan can be difficult, as many community clinicians may be unfamiliar with CRS and require additional education on its recognition and management. After-hours coverage can also pose risks, since call schedules may include non-hematology physicians who lack experience with CRS-related toxicities.
“The feedback that we were getting from our community providers is that there’s a lack of instruction. The patient comes back, and [they] don’t have completed medical records or don’t have a treatment history, and [from that point], there’s little guidance,” Lin said. “[Many community colleagues said that they] need to do bridging therapy for a patient while waiting for the cells to be manufactured but weren’t given instructions. Academic centers need to provide clear communication and document clinical histories and management so that it can be streamlined for patients and there’s not this gap.”
Beyond workflow coordination, resource accessibility remains a significant barrier for many community practices. Many community oncology practices operate with limited infrastructure, smaller clinical teams, and fewer specialized support services compared with academic centers. This disparity can make it difficult to safely administer complex treatments such as bispecific antibodies, which require close monitoring.
“With bispecific antibodies, [the issue of] step-up dosing [is central]. Many of the community centers [have voiced that] they don’t have the resources. They don’t have properly trained staff on some of these unique [adverse] effects [AEs]. As a myeloma community, we need to focus on training our nurses [and] our physicians on how to manage patients undergoing bispecific therapy,” Catamero noted. “With CAR T-cell therapy, patients do need to be at a CAR T-cell therapy center, but [we need to focus on] bridging that gap of information between the community and the academic center [specifically] how to manage patients when they come back to their community post–CAR T-cell therapy. [It’s important that we remain cognizant of] what AEs, [and] how to manage them. There’s still that knowledge gap in the community.”
Another major challenge identified in the analysis involves building and maintaining strong network partnerships between community practices and affiliated academic hospital systems. Establishing these relationships is essential to ensure smooth coordination when patients require inpatient management, Lin explained.
“There are certainly some pain points with how to build infrastructure [needed to support outpatient administration],” Lin expressed. “We’re happy to share our experience at [the] Mayo Clinic, but I’m sure in the coming years, we’re going to hear more and more from different centers [about their own unique challenges]. There’s not one right model of how to [administer bispecific antibodies]. It depends on [local and regional] resources [and] the infrastructure set-up.”
What role can academic centers play in supporting community-based clinicians as they work to integrate bispecific antibodies into practice?
Academic centers serve as a critical bridge between innovation and implementation, helping to equip community clinicians with the knowledge, tools, and confidence needed to safely administer complex immunotherapies. As bispecific antibodies and CAR T-cell therapies become more widely adopted, academic experts can support community practices through structured education initiatives, mentorship programs, and the development of accessible digital learning platforms. Recent recommendations from the Association of Community Cancer Centers (ACCC) and the Society for Immunotherapy of Cancer (SITC) echo this call for collaboration, underscoring the importance of identifying appropriate patients for bispecific antibody therapy, ensuring comprehensive staff training, and educating patients on symptom monitoring.3
“We need to go out into the community and educate. There are programs and conferences, yes, but many providers don’t have the funding to attend these conferences,” Catamero explained. “We need more [accessible] online resources for [clinicians on] how to administer bispecific antibodies, what toxicities to expect with these novel therapies, and how to best manage them. We need a one-stop resource where providers can look up information so it’s at their fingertips. We [also] need to do more outreach as experts to our community partners to educate on best practices and management.”
References
- Donnellan, MD W, Lin, PhD SW, Abbas, MD J, et al. Operationalization and use of bispecific T-cell–engaging antibodies in community practices: multidisciplinary perspectives on developing logistics and workflow for cytokine release syndrome management. J Adv Pract Oncol. 2025;16(7). doi: 10.6004/jadpro.2025.16.7.19
- Firestone R, Lesokhin AM, Usmani SZ. An embarrassment of riches: three FDA-approved bispecific antibodies for relapsed refractory multiple myeloma. Blood Cancer Discov. 2023;4(6):433-436. doi:10.1158/2643-3230.BCD-23-0176
- A blueprint for successful integration of bispecific antibodies. Accessed November 12, 2025. https://cdn.sanity.io/files/0vv8moc6/accc-cancer/6ff749df8c110fd1e994d9a405cde79817f68d6b.pdf
