Expanding BiTE Therapy Beyond Major Cities: Wade Iams, MD, MSCI

Staff able to recognize and manage immune reactions, along with ready access to a reversal drug, determine whether community oncology practices can offer bispecific T-cell engager (BiTE) therapy, according to Wade Iams, MD, MSCI, of Tennessee Oncology.

In an interview with The American Journal of Managed Care^®, Iams discussed barriers to bringing complex therapies to more sites, what determines whether a practice can offer outpatient BiTE therapy, and the cost of cellular therapy.

Why Complex Therapies Are Hard to Expand

Tennessee Oncology has 35 clinics across Tennessee and into Northwest Georgia, Iams said, yet some of its newest therapies, including BiTE therapy, are still given only in downtown Nashville and downtown Chattanooga. That is a problem for many patients because of transportation, cost, and complexity.

"Trying to get to the downtown location in order to receive these treatments is a barrier," Iams said.

The practice is working to add sites with good infrastructure that are ready to support more complex therapies. Iams named areas such as Clarksville, Murfreesboro, Columbia, Franklin, and the region around Cleveland, Tennessee.

What Determines Outpatient BiTE Readiness

According to Iams, the rate-limiting steps are staffing and access to the antidote. Local staff must be able to recognize and respond appropriately to immune reactions, and the practice must have access to tocilizumab, the infusion that can reverse the reaction.

"Do we have the people and the drugs ready to handle this?" Iams said.

Those are the requirements currently set for which practices can offer full outpatient BiTE therapy. Iams said practices in larger areas that regularly manage more medical complexity have been able to roll out the outpatient model more quickly. Iams expects BiTE therapy to reach outpatient administration across the network.

Why Cellular Therapy Will Stay Costly

Cellular therapies follow a different path. Iams called manufacturing a person's immune system to recognize and control cancer "some of the coolest science going on," but said the treatments are very costly and the manufacturing processes are intensive.

"There's not a future where I think those intense manufacturing processes are going to be significantly alleviated," Iams said. In Iams' view, cellular therapies will therefore remain a high cost for the health care system and demanding for patients.