Bringing bispecific therapy into community cancer care

Bispecific antibody therapy is an emerging immunotherapy class showing significant promise in hematologic malignancies and, increasingly, solid tumors. For patients with advanced cancer who progress through standard lines of treatment, access to leading-edge therapies has often meant traveling to academic medical centers.

Nikhilesh Korgaonkar, MD, MBA, FACS

Patients in South Central Pennsylvania can now receive bispecific therapies at WellSpan Health’s community cancer centers. This local access is supported by WellSpan Health’s collaborations with academic medical centers such as Johns Hopkins Medicine and Penn State Health, as well as systemwide infrastructure built for complex immune-based care. The model allows appropriate patients to receive advanced therapy through local oncology teams, with the safety planning and patient support these treatments require.

How bispecific therapy works

Bispecific antibodies are laboratory-engineered proteins designed to target two different antigens simultaneously. Many of the antibodies activate the immune system to destroy cancer cells. Others block signaling pathways that allow cancer cells to multiply.

"You can think of it as linking the T-cell with the cancer cell," says Nikhilesh Korgaonkar, MD, MBA, FACS, vice president and chief medical officer, WellSpan Cancer Institute. "The antibody grabs onto a cancer cell with one end, and the other end grabs onto a T-cell, and it physically brings them together. Then the T-cell releases toxic proteins that destroy the cancer cell."

Bispecific therapy is most commonly used for relapsed or refractory cancer, and indications continue to evolve. WellSpan Health is using bispecifics across several hematologic malignancies and select solid tumors, including:

• Multiple myeloma
• Diffuse large B-cell lymphoma
• Uveal melanoma
• Small-cell lung cancer
• Follicular lymphoma

Making bispecific therapy available locally

The effort to offer bispecific therapy at WellSpan Health grew from a patient need. Lindsay Ebling, RN, senior director of oncology nursing, recalls a patient with late-stage small-cell lung cancer who was searching across Pennsylvania for access to bispecific therapy.

That request spurred WellSpan Health’s work to provide bispecific therapy safely in the community. “Because early doses may require intensive monitoring, some patients may still begin treatment in a setting designed for that level of care,” Ebling says. “We’re now administering maintenance doses at all our cancer centers, and we’re working toward offering the entire course of care, including initial treatments, at WellSpan Health.”

Local access matters for patients facing frequent visits and long monitoring periods. It can reduce travel burden and keep patients connected to the oncology teams, caregivers and support systems they know.

Building the infrastructure for complex therapy

Bispecific therapies carry significant risks. The same immune activation that makes them effective can also trigger cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). These potentially life-threatening complications require rapid recognition and management.

WellSpan Health already had the emergency, ICU and inpatient oncology resources needed to support complex cancer care. To better manage patients who develop concerning symptoms after bispecific therapy, the team aligned those resources around a shared response process. They also added care pathways, EHR alerts and specialized admission order sets to help clinicians recognize CRS and ICANS quickly.

“We needed to make sure that our infrastructure was well-established to fully support these patients when they needed us the most,” Ebling says.

For example, when a patient presents at WellSpan Health with signs of infection within seven days of receiving bispecific therapy, an Epic-based flag prompts clinicians to consult medical oncology and consider CRS or ICANS, rather than defaulting to a standard sepsis workup. The alert helps teams recognize symptoms quickly when they could signal a severe response to the therapy.

Supporting patients and caregivers

Because bispecific therapy can cause serious immune-related reactions, eligibility depends in part on the support patients have at home. Patients must have a reliable 24/7 caregiver who can recognize concerning changes and seek emergency care immediately. They also must live within an hour of an acute care facility.

WellSpan Health supports patients and caregivers through:

• Education: Nurses explain expected side effects, red-flag symptoms and when to contact oncology or seek emergency care.
• Caregiver preparation: Caregivers learn to watch for changes that patients may not recognize themselves, including neurologic or behavioral symptoms.
• Remote monitoring: Patients can report vital signs in their portal and receive support from a dedicated nursing team with daily coverage, including weekends and holidays.
• Hospital at Home: Patients can receive physician, APP and RN support at home through a 24/7 on-call team, extending acute care into the home.

Bringing advanced therapy to more patients

WellSpan Health is preparing for broader use of bispecific therapy across appropriate patient populations as indications expand and care teams continue to refine risk stratification.

“Research and innovation are making these treatments more widely used in solid tumors, which could make them an option for more patients,” Dr. Korgaonkar says.

Bispecific therapy is one example of how WellSpan Health is bringing advanced cancer care to the region. By pairing subspecialty expertise with local oncology teams, safety protocols and patient-centered support, WellSpan Health is helping more patients receive complex treatments in their local community.