Expanding Outpatient Bispecific Antibody Care: Pharmacists Lead Education and Protocol Development

In an interview with Pharmacy Times at the 2026 Community Oncology Alliance (COA) Conference, Brooke Peters, PharmD, BCOP, discusses the transition from inpatient to outpatient administration of bispecific antibodies, allowing more patients to receive care closer to home. She highlights the critical role pharmacists play in developing standardized protocols, educating multidisciplinary teams, and creating patient monitoring tools to ensure safety.

Pharmacy Times: From your perspective at the American Oncology Network, how are community practices evolving their workflows to safely manage the unique administration and monitoring requirements of bispecific antibodies?

Brooke Peters, PharmD, BCOP: So with our bispecific antibodies, we really started with an inpatient or hybrid approach, where we were working with our community hospitals, administering step-up doses in the inpatient setting or, in some cases, administering step-up doses in the clinic and then observing the patient in the hospital after the step-up dose. But we’ve really been evolving that strategy to move patients into the outpatient setting. We now have protocols and treatment plans where patients are monitored in the clinic and at home rather than in the hospital, only visiting the hospital if they have higher-grade toxicities that require higher-acuity care.

Most of our patients are able to receive their step-up doses in the clinic. They get some observation in the clinic, a couple of touchpoints with a provider on days where the label might otherwise suggest hospital observation, and then they are monitored at home. They do have to have a caregiver present, and they need to be in proximity to our health care facility, but most of our patients are qualifying for the outpatient approach.

Pharmacy Times: Bispecific antibodies often require coordination across multiple care teams—how can pharmacists help bridge communication gaps to ensure seamless patient care?

Peters: I think our pharmacists have been integral in educating staff, including nursing staff, pharmacy staff, and providers, and different education is needed for each. That means making sure pharmacy staff understand which vials to order for certain step-up doses, ensuring nursing staff can recognize CRS, ICANS, and other toxicities, and making sure providers are aware of when the risk of toxicity is highest and when they should bring the patient in for monitoring and evaluation.

Education is key, but another piece is SOPs. Pharmacists have been involved in creating SOPs that help improve communication and building those SOPs into the treatment plans in the EMR so nurses know when they need to escalate a toxicity to a provider versus when they or the patient can manage that toxicity at home or in the clinic. Building those instructions for interdisciplinary communication and collaboration into SOPs and into the treatment plan has really improved communication across our network.

Pharmacy Times: What role do you see pharmacists playing in educating both providers and patients on the complexities of BsAb therapies, particularly around safety and adherence?

Peters: I think pharmacists are important in educating both patients and staff. For patient communication, pharmacists can help create patient education materials. AON pharmacists have been involved in developing these materials, as well as patient monitoring sheets for at-home use, ensuring that patients are checking and documenting their temperature, blood pressure, and pulse oximetry at regular intervals. Generally, a nurse or APP provides that education to the patient, but the pharmacist helps create the structure so there is consistency in the message.

As far as educating staff, our pharmacists have helped create a slide deck that has been built into Workday as a module assigned to all new nurses. Regional directors of nursing can also assign it to nurses if they have a new bispecific patient or need a refresher. It covers CRS, ICANS, and other toxicities, helping nurses recognize signs and understand treatment approaches. It also walks through what’s included in our SOPs and where to find them, so staff feel equipped to manage these toxicities.

Pharmacy Times: Looking ahead, what infrastructure or workflow changes do community oncology practices need to implement now to be prepared for the continued growth of bispecific antibody therapies?

Peters: One of the big things is moving into the outpatient setting, especially in the community. We want to keep our patients in the community, where they have chosen to receive care. Being able to administer step-up doses in the outpatient setting and equip patients for home monitoring—or monitor them in the clinic—helps keep as many patients as possible close to home, where they can receive the best care.

Preparing protocols for outpatient management, building treatment plans, and collaborating with peers to determine the best strategy are all essential. Staff education also needs to expand. Right now, we may have core bispecific teams at each site—a nurse, provider, APP, and scheduler—who are well versed in these therapies and can manage current volumes. But as these therapies move into earlier lines of treatment, we will see more patients requiring them. That means the entire staff needs to be trained and familiar with SOPs and treatment plans.