Pharmacists Take On Education and Toxicity Triage in Bispecific Care

Pharmacists in bispecific programs are moving beyond order verification into patient education, adverse effect mitigation, and parts of toxicity triage, though how practices use them varies, speakers said at a webinar hosted by CancerNetwork®, Pharmacy Times®, and The American Journal of Managed Care® as part of The Bispecifics Network.¹ The panel included Ralph Boccia, MD, hematologist-oncologist at the Center for Cancer and Blood Disorders, an American Oncology Network (AON) practice, and chief medical officer of the International Oncology Network; Nicholas Bitz, PharmD, a pharmacist specialist in myeloma and lymphoma at University Hospitals in Cleveland, Ohio; and Lekan Ajayi, PharmD, chief operating officer of Highlands Oncology Group in northwest Arkansas.

Where Pharmacists Take the Lead

When a multidisciplinary team forms around these drugs, every stakeholder needs a seat at the table, Bitz said, including infusion pharmacists and specialists like himself who work in ambulatory clinics. Within pharmacy, dispensing and clinical staff need to understand each other, because the work goes beyond preparing and delivering drugs.

When University Hospitals built its program, pharmacists worked directly with medical teams on administration workflows and adverse effect mitigation. “We’ve really taken the lead in being able to own the education process and own the side effect mitigation as well as parts of the toxicity triage,” Bitz said.

He asks patients to bring their supportive care medications to the first administration and makes sure they know what to do if cytokine release syndrome (CRS) or another adverse event occurs. Education reduces fear among staff and patients alike, Bitz said, “because the patients know what to monitor, who to call, and what to do at the first sign of anything going wrong.” Teclistamab, for example, carries a boxed warning for life-threatening or fatal CRS and neurologic toxicity.²

Filling the Gap Without a Dedicated Pharmacist

Boccia said AON’s clinical research experience led it to decide to bring bispecifics, and eventually chimeric antigen receptor (CAR) T-cell therapy, to every network practice that wanted to administer them. Building infrastructure and standard operating procedures with the network’s PharmD team took “meeting after meeting after meeting,” he said.

His group does not have a dedicated bispecific pharmacist. Instead, a dedicated pharmacy team is part of its T-cell treating team. “We meet once a week to discuss all of the patients, all the upcoming patients as well as the current patients, talk about education and everything else,” Boccia said.

Pharmacists are involved in ordering and administration and are a critical part of discussions about adverse events and their management, he said. That includes making sure the team has drugs such as tocilizumab and dexamethasone on hand to support patients who develop CRS.^3,4

Building Competencies in the Community

Asked about a formal competency or certification track, Ajayi said he sees a growing role for competencies to support safe delivery, in part because the work requires “a different way of thinking.”

From the start, his practice treated bispecifics “as a program, just not as an add-on service,” expecting it to become the foundation for CAR T-cell therapy and other treatments. It has invested in training staff and confirming competencies, which may need to extend to other fields as practices start thinking about solid tumors, he said.

In 2025, the program had a physician, an advanced practice provider, and a nurse. Over the past year, the practice has invested in clinical pharmacy services to help track and monitor patients, work nurses had primarily handled.

Ajayi, a pharmacist himself, said community oncology practices are beginning to understand “the broad impact pharmacists can play,” including therapeutics and what a therapy’s cost structure means. Nurses and pharmacists now work back and forth as patients move through treatment, he said.

References

1. Boccia R, Bitz N, Ajayi L. The Bispecifics Network webinar. CancerNetwork, Pharmacy Times, and The American Journal of Managed Care; October 27, 2026.

2. FDA approves teclistamab and daratumumab for relapsed or refractory multiple myeloma. The ASCO Post. March 25, 2026. Accessed October 30, 2026. https://ascopost.com/issues/march-25-2026/fda-approves-teclistamab-and-daratumumab-for-relapsed-or-refractory-multiple-myeloma/

3. Rodriguez-Otero P, Usmani S, Cohen AD, et al. International Myeloma Working Group immunotherapy committee consensus guidelines and recommendations for optimal use of T-cell-engaging bispecific antibodies in multiple myeloma. Lancet Oncol. 2024;25(5):e205-e216. doi:10.1016/S1470-2045(24)00043-3

4. Ludwig H, Terpos E, van de Donk N, et al. Prevention and management of adverse events during treatment with bispecific antibodies and CAR T cells in multiple myeloma: a consensus report of the European Myeloma Network. Lancet Oncol. 2023;24(6):e255-e269. doi:10.1016/S1470-2045(23)00159-6