­CAPhO Conference 2026

Management of Antibody-Drug Conjugate (ADC) and Bispecific T-Cell Engagers

The Management of Antibody-drug Conjugate (ADC) and Bispecific T-Cell Engagers Workshop takes place at the TCU Place on Thursday, April 23, 2026, from 12:30 to 16:30 CST.

This clinical workshop is designed for oncology pharmacists to master the complexities of managing antibody-drug conjugates (ADCs) and bispecific T-cell engaging therapies. 

Participants will explore the structural determinants of ADCs - including the monoclonal antibody, chemical linker, and cytotoxic payload. Discussion continues of the mechanism by which T-cell engaging (TCE) treatments bridge T-cells and their targets; triggering potent cytotoxic responses and the monitoring pharmacists perform during this time. Through case studies the workshop participants will review the current T-cell targets used to treat hematologic and solid malignancies.

The management of unique adverse events such as Cytokine Release Syndrome (CRS), Immune Effector Cell-Associated Neurotoxicity Syndrome (ICANS), and payload-induced ocular toxicities will be addressed in the case studies.  Additionally, supportive care management will be covered, outlining the responsibility of the pharmacist within the multidisciplinary team.

Finally, the workshop enables participants to leave with tangible workflows for ADC and TCE administration at their centres. Transition-of-care checklists, patient education, and pharmacy staff involvement to support safe outpatient administration will round out the workshop activities.

• Case Study 1: Antibody-Drug Conjugate (ADC)
  Kathy, an active 70-year-old grandmother, was diagnosed with Stage 3B serous epithelial ovarian cancer and progressed to platinum-resistant disease only four months after completing her initial line of carboplatin and paclitaxel. Based on her tumor's high Folate Receptor Alpha (FRα) expression (≥75% intensity ≥2+), she was prescribed mirvetuximab soravtansine (MIRV) monotherapy, receiving a dose precisely calculated using Adjusted Ideal Body Weight (AIBW) to reduce the risk of exposure-related toxicities. During her treatment journey, she experienced blurred vision and was diagnosed with Grade 2 confluent superficial keratopathy, a common but resolvable off-target effect of the DM4 payload on the corneal epithelium. Per safety protocols, her treatment was temporarily withheld until her ocular findings improved to Grade ≤1, demonstrating the vital role of multidisciplinary monitoring and prophylactic eye drop regimens in ensuring the continued benefit of this targeted ADC therapy.
  
  Learning Objectives:
  1. Prophylactic Ocular Regimen Instruction: By the end of this educational session, the pharmacist will be able to comprehensively instruct patients on the mandatory prophylactic ocular regimen, specifying the requirement for ophthalmic topical steroids and the liberal use of lubricating drops to mitigate the risk of treatment-limiting corneal toxicity.
  2. Precision Dosing and Pharmacokinetic Rationale: Given a patient's height and weight, the pharmacist will accurately calculate a patient-specific dose of 6 mg/kg using Adjusted Ideal Body Weight (AIBW) and explain to the healthcare team that this dosing strategy is necessary to reduce the peak concentration (Cmax​) associated with Grade ≥ 2 ocular adverse reactions and peripheral neuropathy.
  3. Toxicity Assessment and Dose Modification: Within a clinical case scenario, the pharmacist will correctly apply Health Canada-approved dose-modification protocols for MIRV-related toxicities, identifying the specific criteria for withholding therapy or initiating stepwise dose reductions (using AIBW) based on CTCAE grading for patients presenting with confluent superficial keratopathy, Grade 2 pneumonitis, or Grade 2 peripheral neuropathy.

• Case Study 2: Bispecific T Cell Engagers
  HN is a 57 yo male with a history of stage IVB high grade B-cell lymphoma positive on IHC for CD10, CD20, BCL2, BCL6 and high Ki-67 of 90-95%. FISH is positive for both MYC and BCL2 rearrangements (i.e. double hit). He was initially treated with RCHOP then DA REPOC but progressed on PET after three cycles.  The patient is not eligible for transplant and was therefore initiated on glofitamab-gemOx.
   
  Learning Objectives:
  By the end of this presentation, participants will be able to:
  1. Explain the mechanism of action of glofitamab and how its unique attributes as a bispecific T-cell engager impact the risk of cytokine release syndrome (CRS). Describe the immunologic and cellular mechanisms by which obinutuzumab is used as a premedication to improve adverse events associated with glofitamab therapy.
  2.  Define the risk factors associated with CRS in this patient population and outline the general principles used to grade this adverse event. Outline pre medications required for reducing glofitamab induced adverse events and duration thereof. Summarize the management principles of CRS in the context of bispecific T-cell engagers including the role of tociliuzumab.
  3.  Review adverse events commonly encountered by patients on glofitamab including infection prevention, tumor lysis syndrome and tumor flare. Discuss viral,and bacterial infection prevention strategies.

• Case Study 3: Logistical Management
  Engaging the immune system to target, detect, and destroy cancerous cells has been one of the fastest expanding mechanisms in cancer care.
  From immunotherapy to antibody drug conjugates (ADC) and T-cell engaging (TCE) therapies: how can oncology pharmacists prepare themselves to provide these therapies at their centres?
  This case will illustrate the workflows to safely initiate ADC and TCE therapies at your local institution using tarlatamab as a patient case example. 
  
  Learning Objectives:
  1. Participants will evaluate which tools in the case are relative to implement ramp up protocols or to modify existing protocols at their institution. Participants will review medication access, patient and care partner supports, and pharmacy readiness within the regimens shared during the workshop for applicability at the local level.
  2. Participants will discuss pertinent details to include in a pharmacy care plan for initial treatment and ongoing care for patients receiving T-cell engaging therapies such as tarlatamab. Participants will prepare a checklist for shared care within their pharmacy care plan to use when treatment transfers from inpatient to outpatient or from one site to another.
  3. At the end of the case, participants will draft a workflow the multidisciplinary team could follow for implementing a step-up dosing program for T-cell engaging therapies. Workshop participants will label activities/tasks each team member at their institution could be assigned during the patient's pathway from treatment discussion - to step up dose - to ongoing full dose administration.