Building Effective Interdisciplinary Teams for Bispecific T-Cell Engager Implementation

Successfully introducing bispecific T-cell engagers (BTCEs) into clinical practice requires more than protocols—it demands seamless interdisciplinary collaboration. In this interview, pharmacy leaders Don Moore, PharmD, BCPS, BCOP, DPLA, FCCP, FASHP, and Brooke Adams, PharmD, BCOP, discuss how they foster strong partnerships across nursing, oncology, and pharmacy, design comprehensive staff education programs, and maintain up-to-date guidelines. From creating shared reference tools to standardizing cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) protocols, their insights reveal practical strategies for ensuring both patient safety and team cohesion as these complex therapies expand into community and academic settings.

Q: Interdisciplinary collaboration is essential but notoriously hard to sustain. How have you built and maintained those relationships across pharmacy, nursing, oncology, and beyond?

Don Moore, PharmD, BCPS, BCOP, DPLA, FCCP, FASHP: So I think when it comes to a really successful program for bringing these drugs into your hospital, into your systems, you need to be very inclusive of others. We really do need interdisciplinary collaboration when it comes to this. So not just academic to community, vice versa, but also who’s in your house, who’s in your backyard right there.

And so one of the ways that we really try to do that is just including them in some of that discussion on, you know, if we’re going to be moving patients in and out of the hospital, well, the advanced practice provider (APP) who might be on that admitting service is going to be doing that. There might be part of that responsibility. Ensuring that we touch base with case management, so they aren’t inadvertently trying to change an observation status or an inpatient status, that we are truly doing that intentionally, letting the nurses know that. Educating on how to detect CRS and ICANS, and what an immune effector cell-associated encephalopathy score is. So a lot of that is how we just include everybody, because everybody is part of the care team.

Brooke Adams, PharmD, BCOP: Yeah, I think it’s about being inclusive and putting yourself out there instead of being the pharmacist that’s behind the scenes, by the computer verifying orders with all of this knowledge in our head. Going out there and showing and becoming friends with these nurses, these APPs, these physicians, and really showing what we as pharmacists can truly do and the value that we can provide to our team, and that we are not scary to approach. We’re extremely friendly. We are there to support them, and you will notice that will change the entire scheme of the interdisciplinary team.

Q: Staff education is a major lift when introducing a new drug class. How did you design your training program, and how do you keep clinical staff current as the evidence and approved indications continue to evolve?

Adams: Yeah, great question. So there’s one thing that I started doing because my physician would literally ask me every single time that we had a patient in clinic on a bispecific: When did they go to every 2 weeks? When do they go to a month? Do they get to go to a month? What are the premeds? What are the postmeds? Because every single bispecific is different. There is not one that is the same.

And so I have made a table, and every single time that a new one launches or there’s new data, there’s a new column in this table. This table gets printed off and emailed, and my physician wishes we could make an app for it. And I was like, “That is way above my savviness when it comes to it,” but that’s a wonderful idea.

And so it is basically kind of just a table of the bispecifics as a reference. Even though it’s in the treatment plans, everyone likes to learn differently. Everyone likes to visually see things or hear things auditorily. Every time there’s a new update or FDA approval, your friendly pharmacist sends your update email on what’s going on. And I do in-person training. We do lectures. I do fellow lectures, and everyone is involved to come to these lectures. So it’s all about staying up to date and keeping everybody informed because education does not stop after an FDA approval.

Moore: So some things that we’ve also done with that too is we moved to having a more aligned CRS and ICANS guideline across all of our bispecifics. And so with that comes education, and so we’re trying to really develop more standardized education that’s going to grow across all teammates who may interact with these types of patients. So we do get that pushed out to them.

It’s actually something we did for checkpoint inhibitors several years ago—really helping to educate all the people in the care team, whether it’s going to be, you know, for those of us in clinic who are doing it, or those on the floor and inpatient. If you see this, this might be an irregular type of side effect we’re not used to in oncology. So we’re kind of starting to move into a very similar, respective manner with that. Yeah.

Adams: I love that. And we’ve done a similar thing too. We’ve decided the “1 size fits most” kind of process that we talked about yesterday—we stole that from our colleague Emilie [Aschenbrenner]—and we decided that, you know what, we are not going to have a CRS and ICANS guideline for every single product. We’re going to combine everything into 1 guideline. We’re going to make one CRS and ICANS order set that has all the grading criteria in it in Epic, and that’s what everybody’s going to be trained on, and that’s what everybody is going to use.

Q: Looking back at your implementation journey, what would you do differently, and what advice would you give to a pharmacist at an institution that is just getting started with BTCEs today?

Adams: I think, looking back, I was at an academic medical center when bispecifics launched, and so we were already doing CAR T-cell therapy, we were already on trials with these bispecifics—so for us, it was extremely easy just to transition over. And I bet, Don, you probably have a very similar experience.

I made the transition to community 2 years ago. The bispecifics were already launched when I got there, but they were launched in 5 different ways. There were services that weren’t comfortable with giving them, so they were treated all on 1 service line—solid tumor, including hematology, including blood and marrow transplant (BMT), including CAR T-cell therapy. And as we know, that’s just not sustainable in life now that we have tumor-infiltrating lymphocytes (TILs), gene therapy—everything is coming to the BMT/CAR T service right now, and there are only so many beds that we can have on that service line that we built in a hospital. You can’t just make more beds overnight.

So training and education—that’s probably something earlier on that we probably could have done better at—is making people feel comfortable and not making it this foreign fruit that, “No, you can’t touch. Only we can manage.” And I feel like we are now coming to the point that we’re trying to push everybody to do this when upfront, I wish we did a better job of that.

Moore: Yeah. Just looking back, I know how we had our model set up for outpatient administration, observation status, and originally it was going to be that we would maintain the maintenance doses, if not initially at the main campus—which actually we did decide very quickly, like, “No, it’s okay. We should send them back home,” because we have our own community-based clinics within the system.

And so I think some of that was, you know, the upfront discussion of the limitations. Maybe it could have been something we could have backtracked, so we didn’t inadvertently—not scare everybody—but seem that we’re imposing a lot of limitations. And now we’re in a situation, you know, I think globally across the country, where we’re really trying to get these drugs out into the community.

Q: Is there anything you’d like to add?

Adams: I think I just want to say that we are all in this together. Don, Emilie [Aschenbrenner], Megan [May], and myself are all willing to help you. All it takes is reaching out. And I’ve already got a couple of emails this morning after our boot camp yesterday, and that’s really exciting to me. That’s amazing that they listened to us yesterday. They appreciated it. They took our advice, and they know that they don’t have to recreate the wheel. And that’s what I hope that we can continue to inspire across the country as we launch these hundreds of bispecifics that are about to come out.