From Treatment to Prevention: How Pharmacists Are Refining CRS Management for Bispecific Antibody Therapy

In this episode, 'From Treatment to Prevention: How Pharmacists Are Refining CRS Management for Bispecific Antibody Therapy,' the oncology pharmacists explore the following questions:

A CRS management plan is key when planning bispecific treatment; agents like tocilizumab or dexamethasone have emerged as two options for management. How are you differentiating these in practice?

What preventative, proactive measures are you taking to mitigate CRS risk?

Low-dose prophylactic tocilizumab was effective in lowering rates of CRS during the step-up dose phase. What are your impressions of this study, and what implications do you see broadly for managing CRS and the administration of bispecifics?

The panelists examined how tocilizumab and dexamethasone are being differentiated in CRS management practice, with a clear framework emerging that reserves tocilizumab for Grade 2 or higher CRS, persistent Grade 1 CRS that does not resolve with corticosteroids, or patients with compromised oxygenation or hemodynamic instability, while positioning dexamethasone as the appropriate first-line response to low-grade CRS, supported by real-world evidence demonstrating its effectiveness in managing Grade 1 events and its potential to keep more patients out of the hospital at a meaningfully lower cost than routine tocilizumab use. The discussion also explored the evolving landscape of CRS prophylaxis, with the panelists describing a patient-individualized approach that considers high-risk features such as elevated tumor burden and significant comorbidities when determining whether prophylactic tocilizumab is warranted, and highlighting the practical value of providing all outpatient step-up dosing patients with a pocket prescription of dexamethasone to initiate at home upon symptom onset while awaiting provider guidance. The panelists further discussed the emerging low-dose prophylactic tocilizumab data with the consensus being that while prophylactic tocilizumab is not warranted for patients who will be admitted and actively monitored, it represents a compelling and increasingly evidence-supported strategy for keeping appropriately selected outpatient step-up dosing candidates safely out of the hospital throughout their entire step-up period.

Throughout the conversation, the experts provide a comprehensive reflection on the field and the factors that may shape how clinicians approach care moving forward.

The next episode in this series, 'The Long-Term Infection Risk: How Pharmacists Are Approaching Prophylaxis and Monitoring in Bispecific Myeloma Care,' features the panelists advancing their conversation on multiple myeloma and focusing on why infection is an increasingly critical long-term concern that deserves as much clinical attention as CRS, and how institutions are implementing prophylaxis protocols, primary IVIG programs, and care transition reviews to protect patients throughout the full duration of bispecific therapy.