Operationalizing BiTE Therapies in Community Oncology: Kaitlyn Schomberg, PharmD

Despite advances in solid tumor treatments, including small cell lung cancer, managing the toxicities associated with bispecific T-cell engager (BiTE) therapies remains a challenge, according to panelist Kaitlyn Schomberg, PharmD, a clinical oncology pharmacist at Cone Health Cancer Center.

Understanding the differences between bispecific therapies—including bispecific antibodies and BiTEs—was a key focus of the panel “Operationalizing Bi-Specifics in Oncology” at the Institute for Value-Based Medicine in Charlotte, North Carolina, on March 31, 2026.

Schomberg noted that clinical alert systems embedded within electronic health records are helping improve care coordination across interdisciplinary teams.

“It helps with people that may not know exactly what to do with CRS [cytokine release syndrome] or ICANS [immune effector cell–associated neurotoxicity syndrome], and it notifies them to call the on-call oncologist,” Schomberg said in an interview with The American Journal of Managed Care^®. “It really gives them the opportunity of, ‘Oh, this is how I’m supposed to manage this. This isn’t just neutropenia. This isn’t just CRS.’”

Schomberg added that adopting BiTE therapies into community oncology settings has been easier than initially expected. Unlike some advanced therapies, BiTEs do not require risk evaluation and mitigation strategies (REMS), which can simplify implementation. Still, providers continue to follow established protocols for managing CRS and ICANS.

At Cone Health Cancer Center, infrastructure limitations—such as the absence of an inpatient unit—make coordination with academic medical centers essential. Currently, patients receive step-up dosing at external centers before returning locally for maintenance therapy. However, Schomberg noted that the program is gradually evolving, with plans to incorporate more inpatient capabilities to better manage treatment delivery and associated costs.

“One of the big things we have to consider when deciding if patients can be treated in the outpatient setting is whether they have adequate caregiver support and if their insurance will cover the treatment,” she said. “If we do need to admit patients early on, it can help with managing both care and reimbursement.”