Scaling Bispecifics and CAR T-Cell Therapy in Community Oncology: From Promise to Practice

At a session during the CPC+CBEx 2025 conference, a panel of leaders in cancer care tackled a central question facing the field: how to move bispecific antibodies and CAR T-cell therapies from academic centers into the community oncology setting. These therapies, which offer durable responses and curative potential, are seeing rising US Food and Drug Administration (FDA) approvals—but still face uneven adoption across practice types.

The panel was comprised of Hycienth Ahaneku, MBBS, MPH, PhD, physician partner at Texas Oncology, James Essell, MD, RPh, chair of cellular therapy at Sarah Cannon Research Institute, Lisa Raff, PharmD, MSParm, BCPS, BCOP, vice president of oncology services at OneOncology, and Samuel Stolpe, PharmD, MPH, head of healthcare quality strategy at Johnson & Johnson. The panel represented diverse expertise across community oncology, pharmacy operations, and quality strategy. Moderator Lavi Kwiatkowsky, founder and CEO of Canopy, framed the discussion around the need to accelerate access to these therapies while managing their complexity and toxicity.

The panel emphasized that the therapeutic impact of bispecifics and CAR T-cell therapy is no longer theoretical. Panelists cited 5-year data for axicabtagene ciloleucel (axi-cel) and ciltacabtagene autoleucel (cilta-cel), showing long-term survival for patients with aggressive lymphomas and myeloma who previously had limited options. CAR T-cell therapy, once restricted to third-line treatment, is moving earlier in the treatment sequence. Bispecifics are also gaining traction, offering effective salvage therapy after CAR T-cell failure and emerging as potential earlier-line options.

Despite this, uptake in the real world remains limited. Only an estimated 20% of eligible patients in the US receive CAR T therapy, and bispecific adoption is also lagging. Panelists noted that most patients are still treated in academic centers, leaving significant opportunity—and responsibility—for community oncology to expand access.

Much of the session focused on why access is limited and what can be done about it. Key barriers discussed included limited community participation in clinical trials, lack of infrastructure to handle adverse events like cytokine release syndrome (CRS) and neurotoxicity, inconsistent hospital partnerships, and gaps in provider and nursing education.

Raff highlighted that early adopters in her network faced a steep learning curve when bispecifics first became available. In the absence of clinical trial participation, community practices had to create their own protocols, often using hybrid models where drugs were administered in clinic and patients were admitted for observation.

Since then, one-third of OneOncology practices have transitioned to fully outpatient administration. These centers use standardized playbooks, patient monitoring tools, and strict triage protocols to ensure safety. However, Raff emphasized that many practices still lack hospital partnerships and must innovate independently to treat high-risk patients locally.

Ahaneku described how Texas Oncology is developing a hub-and-spoke model in which a central facility initiates treatment and supports regional physicians. While some locations benefit from affiliated hospital facilities, others must work to establish relationships with local hospitals. A major challenge, he noted, is hospitals’ reluctance to guarantee bed availability or stock emergency medications like tocilizumab. Even with leadership buy-in, scalability remains a concern.

“You give the patient the medication, and the hospital doesn’t keep a bed,” said Ahaneku. “They promise to, but when you need it, it’s not there.”

Raff echoed this concern, describing how her team has had to “stock tocilizumab in little red tackle boxes” and even eat the cost when hospitals refuse to stock it. “In the community, not treating is never an option for us,” she said.

These solutions, while innovative, highlight the need for systemic support rather than relying on individual efforts.

Panelists agreed that successful implementation depends not on individual effort alone, but on systematized care pathways. Stolpe noted that while about 30% of bispecific administration is now occurring in community settings, a larger share remains concentrated in academic institutions. He emphasized that closing this gap requires dedicated investment in infrastructure, including standardized protocols, predictive risk models, and monitoring platforms.

Remote therapeutic monitoring tools were discussed as one way to improve safety and scale. Several practices now use platforms that prompt patients to report symptoms on a set schedule and triage alerts to nurses based on risk. This automation helps reduce reliance on round-the-clock manual follow-up and gives clinicians confidence to treat patients in outpatient settings.

While CRS and immune effector cell–associated neurotoxicity syndrome (ICANS) remain concerns, the panelists emphasized that real-world incidence is manageable. Adverse events typically appear early and can often be preempted or managed with appropriate monitoring and early intervention. Practices are increasingly training nurses and physicians across specialties to recognize and manage these toxicities.

The question of prophylactic tocilizumab use emerged as a point of debate. Some panelists supported it as a confidence-building measure, particularly when hospital access is limited. Others argued for more selective use based on risk stratification and cost considerations. While the data is still evolving, most agreed that lowering the perceived barrier to entry—by supporting clinicians with clear protocols and monitoring tools—will improve uptake.

Looking forward, the panel was unified in its belief that widespread adoption of bispecifics and CAR T-cell therapy is both necessary and inevitable. Immunotherapy, once met with similar hesitation, eventually became standard practice through persistence, education, and adaptation. Panelists anticipate a similar trajectory for cellular therapies.

However, success depends on scaling operations efficiently and ensuring that therapies do not remain siloed in academic centers. Without community uptake, patients will continue to face barriers related to geography, income, and health system capacity.

As Raff put it succinctly, “Therapies are only innovative if they get to patients.” For community practices, the next step is not waiting for the perfect model—but beginning with what they have, building out systems, and committing to learning and iterating.

Reference
Kwiatkowsky L, Ahaneku H, Essell J, Raff L, Stolpe S. Novel therapy imperatives part 1: incorporating bispecific antibodies, CAR-T in the outpatient/community setting. Presented at the Clinical Pathways Congress; September 5, 2025; Boston, MA.