Managing Bispecific Logistics: Remote Monitoring and CRS Mitigation Strategies

As bispecific antibodies become a cornerstone of modern oncology, the logistical challenge of managing cytokine release syndrome (CRS) has moved to the forefront of clinical operations. Although step-up dosing is essential for safety, the intensive observation period can strain both patients and clinical resources.

In this interview segment, Ralph V. Boccia, MD, FACP, detailed his team’s proactive approach to outpatient monitoring. By equipping patients with comprehensive “monitoring kits”—including tools for tracking blood pressure, oxygen levels, and temperature—Boccia demonstrated how a combination of home-based checklists and virtual visits can create a safety net that rivals inpatient care.

Boccia also shed light on their pharmacological protocol, explaining how the strategic uses of dexamethasone and the IL-6 inhibitor tocilizumab (Actemra) allow for rapid intervention at the first sign of CRS. This streamlined workflow not only ensures patient safety but significantly reduces the need for hospital admissions, keeping the focus on effective, accessible community-based care.

Boccia is the founder of The Center for Cancer and Blood Disorders, clinical associate professor at MedStar Georgetown University Hospital, and medical director of the International Oncology Network Clinical Research Program.

Transcript:

What we do is we provide [patients] with a kit. The kit includes a blood pressure cuff, an oxygen sensor, and a thermometer. We then provide them with a checklist of things to record, and they record it on a checklist so that we can discuss that checklist, either live if they come to the clinic, or [during] the virtual visits. We’re able to look for fever, we’re able to look for hypoxia, and we’re able to look for blood pressure changes. We’re able to look for mental status changes and therefore be prepared to intervene. We give them prophylactic dexamethasone, and at the first sign of CRS, cytokine release syndrome, we then give them tocilizumab, which is an IL-6 inhibitor, which often immediately corrects the fever, the hypoxia, and the hypotension so that we’re prepared, in the clinic, to administer these medications if needed. We send them home with dexamethasone, and at the first sign of a fever, we have them take an additional dose of dexamethasone. Often, that’s all it takes. If it isn’t sufficient, within a couple of hours, we are going to be administering the tocilizumab. We could do that in the clinic, and we can often avoid the patient needing to go to the hospital.