Summary of First-Time Attendance at the ATOPP Summit

Betty M. Chan, PharmD, BCOP, Senior Executive Director & Chief Pharmacy Officer, Roswell Park Comprehensive Cancer Center

Anthony Boyd, PharmD, BCPS, Senior Director of Pharmacy, Oncology & Infusion Services, Cleveland Clinic

Chan and Boyd

Attending the ATOPP Summit for the first time in July 2025 was an enriching and impactful experience. The summit provided a dynamic platform to connect with fellow oncology pharmacy professionals, fostering meaningful conversations and new collaborations during many of the dedicated networking sessions. These interactions not only strengthened professional relationships but also sparked valuable exchanges of ideas and best practices and were an invaluable experience.

Another standout aspect of the summit was the deep dive into clinical data surrounding the upcoming pipeline of oncology drugs in development. Presentations from leading researchers and industry experts provided insights into emerging therapies, mechanisms of action, and trial outcomes, equipping attendees with forward-looking knowledge to inform clinical decision-making.

The clinical sessions were also very relevant, addressing current challenges faced in oncology practice, including improvement to oncology medication access and oral oncolytics, operational playbooks for biosimilars, generics, and 505(b)(2), value-based care and enhanced oncology model era, tumor agnostic approvals, gene therapy in sickle cell disease, discussion on bispecific T-cell engagers, and cancer care at home. These discussions were both timely and practical, offering solutions and perspectives that could be immediately applied in real-world settings.

Highlights from General Session

Presentation on “Double Duty: Lessons and Leaps in Bispecific T-Cell Engagers”

  • Megan Mullalley, PharmD, BCOP, BCPS – Intermountain Health
  • Emily Chheng, PharmD, BCOP – Cleveland Clinic, Taussig Cancer Institute
  • Kristen Boykin, PharmD, BCOP, BCPS – Florida Cancer Specialists & Research Institute
  • Grace Baek, PharmD, BCOP – UW Medicine & Fred Hutchinson Cancer Center

The panel discussed recent FDA-approved bispecific T-Cell engagers, which include blinatumomab (CD19+CD3 for ALL), teclistamab and elranatamab (BCMA+CD3 for MM), talquetamab (GPRC5D+CD3 for MM), glofitamab (CD20+CD3 for DLBCL), epcoritamab (CD20+CD3 for DLBCL & FL), mosunetuzumab (CD20+CD3 for FL), tebentafusp (GP100+CD3 for Uveal Melanoma), and tarlatamab (DLL3+CD3 for SCLC). The panel highlighted common toxicities such as cytokine release syndrome (CRS) and neurotoxicity (ICANS), along with other adverse events, including B-cell aplasia, dermatologic and oral toxicities, hematologic and hepatic toxicities, and infectious complications. CRS grading and treatment were also discussed: with antipyretics therapy recommended for Grade 1, and corticosteroids, tocilizumab, as well as ICU monitoring for Grades 2 to 4. For ICANS, the panel reviewed the use of American Society for Transplantation and Cellular Therapy Immune Effector Cell (ASTCT IEC) score for grading, and emphasized supportive care measures including corticosteroids, seizure prophylaxis, and ICU monitoring for Grades 1 to 4.

Operational models for bispecific implementation were shared, highlighting transitions from inpatient to outpatient care underway at many institutions. Key components for outpatient success include multidisciplinary coordination, standardized REMS documentation, and patient selection criteria. Sequencing strategies between bispecific and CAR-T were also discussed, with considerations that include prior treatments, timing of disease relapse, prognostic features, and agent accessibility. To conclude, the panel shared updates on pipeline developments for bispecific T-cell engagers targeting both solid tumors and hematologic malignancies.

Presentation on “Tumor Agnostic Approvals: One Size Fits All?”

  • Amber B. Cipriani, PharmD, BCOP – UNC Health, Precision Medicine Pharmacy Coordinator
  • Mark Zangardi, PharmD, BCOP – Ohio Health, Oncology Precision Medicine Pharmacy Coordinator

The panel discussed recent FDA-approved drugs targeting specific genomic alterations across multiple tumor types which include repotrectinib, entrectinib, larotrectinib (NTRK fusions), fam-trastuzumab deruxtecan (HER2+), selpercatinib (RET fusion), dabrafenib + trametinib (BRAF V600E), dostarlimab (dMMR), pembrolizumab (dMMR/MSI-H, TMB-H), pembrolizumab (dMMR/MSI-H, TMB-H). The panel also reviewed the types of biomarker testing used in oncology with IHC (protein expression), FISH (gene rearrangements), PCR (specific gene mutations), NGS (comprehensive genomic profiling), and algorithmic tests (e.g., Oncotype DX). They discussed how biomarker testing is integrated into the cancer care pathway - at diagnosis, during treatment response, and upon disease progression or recurrence. The panel also discussed the clinical utility of liquid biopsies and the distinction between germline and somatic testing. Two clinical trials were appraised for their role in characterizing the efficacy of tumor-agnostic agents. LIBRETTO-001 trial (selpercatinib for RET fusions) and DESTINY-PanTumor02 trial (fam-trastuzumab deruxtecan for HER2+). The data reviewed highlighted variability in response across tumor types and biomarker expression levels. Key endpoints included ORR, PFS, OS, and DoR. The panel emphasized that clinical trial data must be interpreted in context. While trials may show promising results, efficacy often varies by tumor type and biomarker level; not all patients with a given biomarker will benefit equally.

Additionally, complex biomarkers require nuanced interpretation. For example, dMMR, MSI-H, and TMB-H are interrelated, but they are not interchangeable. Discordance between tests may arise due to technical or biological factors. Cancer-specific thresholds (e.g., for TMB) may improve predictive accuracy and should be considered. Challenges to implementing tumor-agnostic agents in oncology clinical practice were also discussed, including: 1).  Logistical barriers with tissue availability, timing of testing, and access to testing platforms; 2). Clinical integration with the role of Molecular Tumor Boards (MTBs), Electronic Health Record (EHR) integration, and decision support tools; 3). Educational needs for clinicians and pharmacists; 4). Cost, coverage, and regulatory issues. Key takeaways – tumor-agnostic therapies require critical appraisal and individualized care. Biomarker thresholds may vary by cancer type. Implementation requires a robust infrastructure and interdisciplinary collaboration.

Presentation on “Cancer Therapy at Home”

  • Cassandra Redmond, PharmD, MBA, FACHE- Penn Medicine
  • Donna Capozzi, PharmD, BCOP- Penn Medicine

The panel discussed the approach at Penn Medicine to providing oncology care at home. Penn Medicine has 18 infusion suites throughout the enterprise and two home infusion compounding pharmacies to support the delivery of patient care. Based on projected home infusion trends from 2024-2034, the following themes are important to oncology care providers: increase in utilization, reimbursement expansion, increase in drugs in the pipeline, high demand for immune globulin products, and expanded in-home cancer therapy programs. The Penn Home Infusion team has ONS-certified nurses and has programs emphasizing safety including first dose administration programs, medication infusion-related sit-throughs, and chemotherapy double-check. There are important factors that must be considered when exploring drug selection in the homecare setting, including: drug stability and storage requirements, route of administration and infusion duration, nursing requirements for clinical care and potential for infusion-related reactions, regulatory compliance requirements including USP <800>, as well as payer coverage and potential financial impact.

The Penn Medicine team discussed a few drugs that they provided, including treatment medications and supportive care, with the most common medications dispensed, including blinatumomab, bortezomib, fluorouracil, leuprolide, and trabectedin. The team reviewed a patient case with EPOCH in the homecare setting and discussed ordering, scheduling coordinating, lab scheduling, regimen complexity, and the need for patient education. Potential clinician and patient bias that need to be overcome for success with strategies discussed including providers & patients aligning with past experiences, physicians tailoring practice to groups of patients where might miss subgrouping most benefitting from homecare options, complicated EHR ordering. The panel discussed payer strategy and that many payers have mandatory site of service programs. The group discussed factors to be considered around homecare administration of immune checkpoint inhibitors including patient, health-system, and payer considerations. While the Penn Medicine team has found success in establishing a homecare program for Oncologic therapies, coordination barriers between patients and clinical teams had to be overcome. There is also a wide organization return on investment and patient out-of-pocket costs between payers and drugs where further payer negotiations will be critical for the continued success of the program.

In addition to the general session, the availability of Board-Certified Oncology Pharmacist (BCOP) credits added significant value for attendees seeking to maintain certification and advance their professional development. The summit’s educational offerings were thoughtfully curated to meet high standards of continuing education.

Conclusion

Overall, the ATOPP Summit proved to be a vital experience for staying at the forefront of oncology pharmacy, building professional networks, and enhancing clinical expertise. This will be a conference I will continue to support and recommend to other clinical oncology pharmacists and leaders.

References

Bispecific T-Cell Engagers

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Tumor Agnostic Approvals

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Cancer Therapy at Home

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