Implementing a Bispecific Antibody Program in Community Oncology—Insights From the American Oncology Network

Bispecific antibodies have emerged as a transformative class of therapies in multiple myeloma and beyond, but the need for monitoring and managing unique adverse events has historically concentrated their use within academic medical centers. As the pipeline of approved bispecific antibodies expands to a wider patient population, community oncology practices face both the challenge and the imperative of bringing these treatments closer to where patients live.

In an in-depth interview with Targeted Oncology, Melody Chang, RPh, MBA, BCOP, vice president of pharmacy operations at the American Oncology Network (AON), shared her insights from AON’s successful implementation of a bispecific antibody program including outpatient administration. In this interview, Chang explored the clinical, operational, and educational foundations that are needed to establish a program that can provide these novel therapies to patients who need them safely and effectively.

Targeted Oncology: Could you discuss why it is so important to expand access to bispecific antibodies across AON’s network?

Melody Chang, RPh, MBA, BCOP: Several converging factors are making outpatient bispecific antibody programs increasingly important across community oncology. First, we are seeing significant pressure on health care systems, including hospital capacity constraints and resource limitations. As the demand for advanced therapies continues to grow, it’s important to identify safe and effective ways to deliver care outside of the inpatient setting, whenever appropriate.

A second is that the patients increasingly prefer receiving treatment close to home, so outpatient care can improve not only convenience but also reduce the disruptions to their daily life and often lower the overall cost of care. This is the second factor aligned well with the broader movement toward value-based oncology care. The third one is that the bispecific antibody pipeline is expanding rapidly across multiple disease states, not only multiple myeloma. As more therapies become available, community oncology practices must be prepared to provide access to this innovative treatment.

At AON, we believe that patients should not have to travel to any academic center to receive cutting-edge cancer care. Our goal is to build the clinical and operational infrastructure necessary to safely deliver this therapy within the community where our patients live. These are the 3 reasons I think it’s important to AON to introduce the bispecific antibodies [as] outpatient.

What protocols were required to establish access, and how did AON go about this process?

Successfully implementing bispecific antibodies requires much more than adding a new therapy to a treatment pathway. It requires a comprehensive framework focused on safety, consistency, and operational readiness. At AON, we developed standard protocols that addressed patient selection, dosing workflows, toxicity monitoring, infection prevention, emergency preparedness, and caregiver engagement. Given the unique risks associated with bispecific antibodies, particularly cytokine release syndrome [CRS] and immune effector cell–associated neurotoxicity syndrome [ICANS], we established clear monitoring and escalation pathways across the network.

We also implemented the standard standardized education and competency requirements for physicians, nurses, pharmacists, and support staff. In addition, we created operational processes to ensure appropriate medication access, documentation standards, communication pathways, and availability of supportive medications, such as tocilizumab [Actemra]. Standardization has been a key component of our approach by creating a consistent framework across the practice, we can support safe implementations while allowing flexibility to meet the needs of individual sites.

What role does AON’s pharmacy team serve in supporting patient care with bispecifics?

The pharmacy team is very important and plays a critical role throughout the entire treatment for patients receiving bispecific antibodies. The pharmacist involvement begins long before the treatment initiation. Pharmacists contribute to protocol development, formulary management, medications, procurement, supportive care planning, and staff education. We also collaborate closely with the physicians and the nursing treatment team to establish evidence-based treatment pathways and toxicity management strategies.

Once the treatment begins, pharmacists help ensure appropriate dosing, monitor for adverse events, support CRS or ICANS management, and assist with infection prevention and supportive care interventions. Beyond direct patient care, pharmacy teams are often instrumental in driving program development, quality improvement initiatives, initiative outcome tracking, and ongoing provider education. Bispecific antibody programs are highly multidisciplinary by nature, and pharmacy serves as an important bridge between the clinical care operational execution and medications management.

How do you make sure patients can receive bispecific antibodies safely?

Before a patient ever receives their first dose, we have a well-defined process already in place. Once a physician decides to initiate treatment and enters the order into theelectronic medical record, the pharmacist receives an automatic alert and immediately coordinates with the clinical staff and cellular therapy team. From there, a comprehensive checklist is completed to ensure every safety requirement has been addressed. If a REMS [Risk Evaluation and Mitigation Strategy] program applies, we confirm that enrollment and certification are in place prior to treatment initiation.

Staff education and patient education are both verified before the first dose is administered. For our outpatient program in particular, patients must be equipped to self monitor at home, so we ensure they receive all necessary monitoring supplies before leaving the clinic. We verify that dosing is accurate, confirm that tocilizumab is accessible and on hand, and establish the pharmacy team as a direct point of contact for any questions or concerns. Most importantly, we ensure that every patient and caregiver understands the escalation process, so that if a toxicity event occurs, the right steps are taken without delay.

How do you determine how to best provide bispecific antibodies across each individual practice?

We standardize our protocol, but we also have to make sure it’s individualized for the practice; they have a different staffing model and different locations. Our approach is guided by the principle that successfully implementations must be tailored to the capabilities and the resources of each practice by maintaining a consistent standard of patient safety.

When evaluating readiness, we assess several factors, including physician experience, nursing competencies, pharmacy support, infusion capacity, emergency response capabilities, and the patient population’s characteristics. We also consider practical factors such as caregiver availability, social support system, geographic considerations, and proximity to a higher level of care if escalation becomes necessary.

Not every practice begins at the same stage of readiness, and that’s expected. Some sites may be prepared to launch outpatient step-up dosing program immediately, while others may benefit from additional education, training, or infrastructure development before expanding the services. Our goal is to ensure that every practice has the appropriate resources and support necessary to safely deliver bispecific therapy, while meeting the unique needs of their patients and communities.

How has AON’s approach evolved as you have implemented this in practice?

Closing the educational gap has been central to our success. Pharmacists have played a pivotal role in driving education across the network—preparing, launching, and scaling our outpatient bispecific program system-wide.

We began with a pilot at 2 practice sites in November 2023, focusing on staff education and appropriate patient identification. Over the following 6 months, we refined our protocols and workflows based on real-world experience, and in April 2024, we launched the program across our entire network.

Since that launch, we have successfully administered nearly 4000 bispecific doses. Education remains an ongoing priority—we delivered 12 webinar sessions last year and are committed to another 12 this year. Most recently, on June 16, 2026, we hosted our first AON Bispecific Summit, bringing together experienced physicians from across the network to share clinical insights and operational best practices with their peers. Through this culture of continuous learning, we ensure that our staff stays current with an evolving field while benefiting from the collective expertise within our own system.

What should community oncologists know about implementing bispecific antibody programs effectively?

The most important message is that bispecific antibodies can be implemented successfully and safely in the community setting when supported by strong clinical and operational foundations. The initial perception was that these therapies would primarily remain within the academic centers because of their complexity. However, real-world experience has demonstrated that community practice can effectively deliver this treatment when appropriate protocol education and multidisciplinary support systems are in place.

For practices considering implementation, I would emphasize the importance of investing in staff training, developing standardized workflows, establishing clear toxicity management pathways, and prioritizing patients and caregiver education. Equally important is fostering collaborations among the physicians, nurses, pharmacists, administrators, and other members of the care team. Successful bispecific programs are built on teamwork and shared accountability. As the field continue to evolve, I believe community oncology will play an increasingly important role in expanding the access to these transformative therapies by combining innovation with operational excellence, we can ensure that more patients benefit from advanced care and treatments without having to leave their local community.