Hematology-Oncology Associates of CNY (HOA) has successfully treated a patient with bispecific antibody therapy for small-cell lung cancer as an outpatient. Reports show that while this therapy has been successfully administered in the outpatient setting in other parts of the United States, this is the first time it has been provided for someone outside of the hospital in New York State.
Bispecific antibody therapy is a powerful treatment option for patients with liquid and solid tumors that uses the body’s own immune system to fight the disease by binding to two different cells – the disease cells and T-cells (a type of white blood cell that protects the body from infection and fights cancer). Studies show that depending on the bispecific agent, up to 60% of patients receiving therapy have a positive response whereby disease progression is slowed or stopped, thus improving their quality of life and extending their life expectancy.
Prior to HOA’s program, the risk of complications from bispecific therapy’s initial dosing period required a patient be admitted to the hospital for administration of the medication and monitoring of reactions which many times do not occur. The hospital stay for bispecific therapy can range from a day or two on multiple occasions up to as long as 14 days.
“Our program includes a very sophisticated outpatient monitoring plan that allows our patients the freedom to stay at home, avoiding potential infection risks, costs associated with a hospital stay, and time away from family,” explains medical oncologist Steven Duffy, M.D., physician champion for the Bispecific Therapy Program and HOA’s director of research. “Improving our patients’ quality of life during treatment for cancer and hematologic conditions is the impetus for this new program. We want to embrace these exciting new therapies so that people can get the best treatments close to home.”
How the Outpatient Bispecific Antibody Therapy Program Works
Patients in the program are required to have an at-home caregiver and live within a one-hour drive to HOA’s East Syracuse office and Crouse Hospital. Additionally, each patient and their caregiver receives extensive education before agreeing to participate in the program. That education includes understanding how to use an electronic blood pressure monitor, pulse oximeter and thermometer, which are all sent home with the patient.
During a patient’s initial dosing period – the time period during which the patient is at the greatest risk for adverse events — HOA’s bispecific therapy team closely monitors the patient with help from the at-home caregiver who checks the patient’s blood pressure, pulse and temperature every four hours while awake. HOA clinical staff call the patient’s caregiver every eight hours during the initial dosing phase to receive report of the vitals and discern if there are any abnormal reactions to the medication.
Reactions are classified into three grades.
• Grade 1 reactions can be managed at home with an oral steroid and Tylenol and continued monitoring.
• Grade 2 reactions — no matter the time of day — require the patient to be driven to the HOA office where they will be met by a physician, an advanced care provider and other clinical staff who will administer a rescue medication and fluids.
• If a patient has a grade 3 reaction or worse — which happens in less than 3% of all cases — they must be driven to the Crouse Hospital’s emergency department and will be admitted to the intensive care Unit. Crouse staff have received special training for this occurrence and are ready to respond as necessary. Additionally, each patient carries a special card identifying they are being treated with bispecific therapy and must be treated at Crouse.
“It’s important to note that HOA has been treating patients with bispecific therapy in a maintenance mode for several years,” says Duffy. “It’s just the initial, or ramp-up, dosing process that is new for us, but easily accommodated by our highly trained staff who are extensively familiar with monitoring reactions from chemotherapy and immunotherapy.”
Commitment to Our Community
“Providing bispecific therapy at HOA is what community oncology is all about — making cutting-edge treatments available to all, not only to those with access to large centers. Treating our patients at HOA allows them to go home at the end of the day to the comfort of their own home,” explains HOA’s CEO Maryann Roefaro. “Prior to this new program patients were asked to travel outside of Central New York and spend time away from their loved ones in a hospital setting.”
HOA also intends to add clinical trials using bispecific antibodies in the outpatient setting to their already established clinical trial program.