Cell therapy and bispecific antibody administration in community oncology: a case study–based implementation roadmap

Background:

Bispecific antibodies have transformed cancer therapy but remain largely inaccessible in community oncology due to cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) concerns requiring hospitalization and intensivemonitoring.

Objectives:

• Evaluate the impact of prophylactic tocilizumab on the incidence of CRS and ICANS during outpatient administration of bispecific antibodies in community oncology settings.
• Implement a structured outpatient workflow for safe community-based delivery of bispecific antibodies that reduces hospitalization and treatment burden while maintaining clinical efficacy.

Methods:

We implemented prophylactic tocilizumab administration prior to bispecific antibody infusion at a community oncology practice across follicular lymphoma, small cell lung cancer, and multiple myeloma patients receiving epcoritamab-bysp, mosunetuzumab-axgb, tarlatamab-dlle, and teclistamab.

Results:

No high-grade CRS or ICANS events occurred. All treatments were delivered entirely in outpatient community settings without hospitalization. Patients achieved responses consistent with pivotal trial data while experiencing substantially reduced treatment burden compared to traditional protocols.

Conclusions:

Prophylactic tocilizumab enables safe community-based bispecific antibody delivery. This case study-based analysis provides a detailed implementation roadmap for community practices to expand therapeutic capabilities while advancing health equity.

Funding: Not applicable.