Implementation of Bispecific Antibodies in the Community: Lessons From the ThedaCare Cancer Center Experience

T-cell bispecific antibodies (bsAbs) bind a tumor-associated antigen and the CD3 molecule on T cells, inducing direct T-cell-mediated tumor killing. T-cell bsAb therapies have high response rates and improved survival, mostly in relapsed and refractory hematologic malignancies, but pose challenges in clinical practices because of toxicities such as cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). Despite the proven efficacy and off-the-shelf availability, their use in community settings remains limited. At ThedaCare Cancer Center, collaboration with Froedtert Hospital enabled the community implementation of bsAb therapy. Given limited literature in this area, we sought to review our experience to highlight lessons and ongoing challenges in this area. Key strategies included appointing a project champion, forming a multidisciplinary bsAb team, designing educational modules, and integrating clinical decision support tools such as order sets and best practice advisories into the electronic medical record (EMR) system. Pharmacists played vital roles in drug handling, toxicity management, and financial logistics. Training programs focused on recognizing and managing bsAb-related side effects, while EMR tools supported early intervention. Challenges included operational logistics, specialized staffing, and financial barriers. Addressing these requires institutional commitment, caregiver education, financial navigation, and collaboration with academic centers. Structured workflows, provider and patient education on CRS and ICANS symptoms, and around-the-clock support systems are important. Our experiences set a framework for the broader implementation of innovative cancer therapies that share similar therapeutic mechanisms and potential side-effect profiles.