Building Community Infrastructure for Bispecifics and CAR T

As advanced therapies such as chimeric antigen receptor (CAR) T-cell treatment and bispecific antibodies move into community oncology practices, having the treatment available is only one part of being able to administer it safely, according to Bhavana Bhatnagar, DO, associate professor of medicine at West Virginia Cancer Institute at Wheeling Hospital.

“A lot of it, at least where I work, is related to infrastructure,” Bhatnagar said.

She emphasized that administering a bispecific antibody is not simply a matter of a physician prescribing the treatment. Multiple members of the care team need to understand the therapy and respond to potential complications. That team can include pharmacists, outpatient and inpatient nursing staff, and emergency department physicians, among others. These stakeholders need to be familiar with the therapies because their involvement may be necessary to safely manage patients.

Building that familiarity can take time, Bhatnagar noted. When clinicians and other staff are unfamiliar with a therapy, there can be a tendency to avoid administering it locally. However, patients often want to receive treatment closer to home, making the development of community-based infrastructure important.

“Definitely building the infrastructure and making sure that all of the key stakeholders are in place at a community practice in order to safely manage these patients, I think, is critical,” she said.

Bhantangar also highlighted the need for education focused on treatment-related toxicities. Community teams need to know what toxicities to watch for, how to manage them, and whom to contact when an issue arises. Establishing clear standards of practice is another component of bringing these therapies into community settings.

In addition, she said community practices would benefit from a formal connection with a major academic medical center. Having a liaison or an experienced physician available to contact would provide support when an unusual situation arises or when clinicians simply want another perspective on managing a patient.

For Bhatnagar, the combination of infrastructure, multidisciplinary education, standardized practices, and access to experienced academic colleagues can help community practices build the support needed to administer advanced therapies while allowing patients to remain closer to home.