Work

989 Beyond CRS: emerging longitudinal safety management strategies for T-cell–engaging bispecific antibodies

Year: 2026

Type: conference-abstract

Abstract: Background T-cell–engaging bispecific antibodies (BsAbs) are rapidly expanding across hematologic malignancies and emerging solid tumor indications. Through a national educational initiative, the Association of Cancer Care Centers (ACCC) engaged oncology professionals to identify implementation challenges and best practices for BsAb delivery. While early implementation efforts have focused on managing cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) during step-up dosing, less is known about real-world approaches to longitudinal toxicity surveillance. As experience with BsAbs grows, attention is shifting toward monitoring immune-related complications beyond treatment initiation. This analysis characterized evolving toxicity management practices across diverse oncology care settings.Methods ACCC conducted a qualitative analysis using data from six in-person workshops and ten virtual ‘Office Hours,’ representing more than 350 cumulative participant and faculty engagements across community and academic oncology programs in the United States. Session transcripts, faculty insights, and participant discussions were analyzed using inductive thematic analysis and coded in Dedoose to identify recurring themes related to toxicity monitoring, escalation pathways, and longitudinal safety management.Results Participants described established institutional protocols for CRS recognition and management; however, substantial variability emerged in approaches to ongoing toxicity surveillance.Discussions centered on four recurring toxicity-management domains:Fever management and escalation pathways: Participants reported inconsistent approaches to low-grade fever management, outpatient triage, caregiver-reported symptoms, and thresholds for evaluation or hospitalization.Neurotoxicity surveillance: Although ICANS was discussed less frequently than CRS, programs described variation in immune effector cell encephalopathy (ICE) score collection, monitoring duration, and reliance on caregiver-reported symptoms to identify delayed neurologic changes.Longitudinal immune dysfunction and infection risk: Discussions frequently focused on persistent cytopenias, hypogammaglobulinemia, infection prevention strategies, and intravenous immunoglobulin (IVIG) use in hematologic malignancies. Participants expressed uncertainty regarding monitoring and prophylaxis strategies and concerns about resource planning as patient volumes increase.Outpatient safety infrastructure: Established outpatient programs described defined after-hours coverage, standardized triage algorithms, escalation pathways, caregiver education requirements, and selective use of supportive interventions including prophylactic tocilizumab and pre-prescribed ‘pill-in-pocket’ dexamethasone for early management of emerging symptoms.Conclusions Findings suggest BsAb implementation is evolving beyond early CRS and ICANS management toward longitudinal surveillance of immune-related complications. Variability persists in infection surveillance, hypogammaglobulinemia management, cytopenia monitoring, and delayed toxicity recognition. Standardized frameworks for longitudinal immune surveillance may support broader adoption of T-cell–engaging therapies. Current experience with toxicity management is largely derived from hematologic malignancies; additional data are needed to characterize toxicity patterns in solid tumor indications.

Source: Journal for ImmunoTherapy of Cancer

DOI: 10.1136/jitc-2026-sitc2026.0989