AON Shares Lessons for Building Safe Outpatient BiTE Therapy Programs

In an interview with Pharmacy Times, Nicole McMullin, regional clinical pharmacist at American Oncology Network, discussed the importance of patient and caregiver education when initiating outpatient bispecific T-cell engager therapy for patients with multiple myeloma, as well as key lessons for community oncology practices developing similar programs.

McMullin emphasized that patients and caregivers must be actively involved before outpatient step-up dosing begins. At AON, patients receiving outpatient BiTE therapy are provided a monitoring kit that includes a blood pressure cuff, thermometer, and pulse oximeter. Nurses or nurse educators meet with patients before treatment to review common adverse effects, explain the signs and symptoms of cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome, and demonstrate how to use each monitoring tool. Patients are also asked to show that they can use the devices appropriately, helping confirm that they and their caregivers are prepared to participate in home monitoring.

Education also focuses on when to contact the care team. McMullin noted that fever is often the first sign of CRS, making it one of the most important symptoms for patients to report immediately. When patients call the clinic, nurses can follow established triage procedures, contact the physician, and determine the appropriate next steps for management.

For other community oncology practices considering outpatient step-up dosing, McMullin highlighted the need to establish a multidisciplinary team at each clinic. This team may include a physician champion, advanced practice providers, regional clinical pharmacists, in-clinic pharmacy staff, infusion nurses, and financial counselors. She noted that financial counselors play an important role in securing authorizations for BiTE therapy and, when used, prophylactic or emergent tocilizumab.

McMullin also stressed the importance of standardized operating procedures, clear role assignment, nurse triage documents, patient education plans, and staff training. AON has treated approximately 60 patients using its all-outpatient approach, with less than 20% developing CRS during step-up dosing; all reported CRS events were grade 1.