Overcoming Operational Barriers to Bispecific Use in Community Oncology

Tara M. Graff, DO, director of clinical research at Mission Cancer + Blood at the University of Iowa Health Care, discussed findings from an analysis examining the real-world implementation of bispecific antibodies in community oncology settings and the operational barriers limiting broader adoption. Published at ASH 2025, the data highlight a steep but surmountable learning curve as bispecifics move from academic centers into outpatient community practice.

Graff noted that community practices face highly variable challenges. Some have the clinical infrastructure to deliver bispecifics but are hesitant to assume the operational lift, including step-up dosing, after-hours availability, and close monitoring for cytokine release syndrome and immune effector cell–associated neurotoxicity syndrome. Other practices are eager to adopt these therapies but lack experience, education, or access to hospital partners for inpatient admission when needed. These differences contribute to clinician discomfort and slow uptake, even as patient demand grows.

Importantly, the study showed that targeted education led to a roughly 33% improvement in clinicians’ willingness to collaborate with multidisciplinary colleagues. Graff emphasized that successful rollout depends on strong multidisciplinary structures, including nursing, pharmacy, advanced practice providers, and access to inpatient services. However, she challenged the assumption that education must always flow from academic centers to community sites. In many cases, she said, community practices benefit most from learning directly from other community groups that have already implemented bispecifics and understand the same operational constraints.

Where academic centers are involved, improved communication is critical. Graff described persistent gaps between academic and community practices that can limit collaboration and discourage outreach. When these communication barriers are addressed and education is delivered in a practical, supportive way, confidence grows and adoption becomes more feasible.

The findings suggest that expanding bispecific use in the community will require coordinated efforts across stakeholders—including academic centers, experienced community practices, and industry—to provide education, mentorship, and operational support. While progress may be incremental, Graff stressed that collective small steps are already making outpatient bispecific delivery more achievable than even a few months ago.