Melody Chang, R.Ph., on delivering bispecifics in community oncology | HSES 2026

Bispecific antibodies and CAR-T therapies are changing cancer treatment, and community oncology practices need to be ready to deliver them, according to Melody Chang, R.Ph., BCOP, MBA, vice president of pharmacy operations at American Oncology Network (AON). Chang spoke with Managed Healthcare Executive at the 2026 Health System Executive Summit.

Most cancer patients in the United States are treated in the community, Chang said, yet these therapies have traditionally been given at academic centers, which are more costly, often far from where patients live and don’t always have inpatient beds available. Delivering them safely in the community could lower healthcare costs and make care more convenient for patients. Many bispecifics and CAR-T therapies have also moved into earlier lines of therapy, she said, and will soon become the standard of care.

Doing that safely takes more than adding a drug to the formulary and building an order set. The issue, Chang said, “is not the drugs” but “the system around the drugs.” Practices need leadership support on the financial side, standardized protocols, education for staff, patients and caregivers, and a clear escalation pathway for the therapies’ distinctive side effects. AON started with a pilot at selected practice sites, revised the process several times until it became a comfortable standard practice and then scaled it across its practices.

Managing cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) in the outpatient setting depends on identifying them early and intervening before they escalate. Education comes first, Chang said, because caregivers are usually the first to notice something is wrong. Standard protocols matter as well, so that clinicians don’t grade CRS or ICANS differently and end up managing them differently. AON developed a wristband with a QR code that patients, caregivers or emergency department providers can scan to reach a website laying out the grading criteria and treatment options.

The approach is working so far, Chang said. In a chart review of AON’s first 70 patients treated with outpatient bispecifics, about 18% developed CRS, all of it low grade and none requiring hospitalization.

In this video, Chang discusses what community practices need in place to deliver bispecifics safely and how AON manages CRS and ICANS outside the hospital.