CAR T Access Challenged by Geography, Cost, and Treatment Delays

For patients who may benefit from chimeric antigen receptor (CAR) T-cell therapy, access remains a significant challenge, particularly because the treatment is still largely concentrated at academic centers. Patients may need multiple visits before, during, and after treatment, including hospitalization and close follow-up for potential long-term complications, such as cytopenias and immunosuppression. These demands can be especially difficult for patients who live far from a CAR T-cell therapy center or their community oncologist.

“The location and the logistics of patients actually getting to the CAR T center is one major barrier,” said Madhav Seshadri, MD, an assistant professor in the malignant hematology group at UCSF Health, who specializes in lymphoma and chronic lymphocytic leukemia (CLL). Seshadri moderated the discussion, “Advancing Frontiers in Leukemia and Lymphoma: Breakthroughs and Barriers,” at the August 11 Institute for Value-Based Medicine^® in San Francisco, “Pioneering the Next Era of Oncology Care.”

Financial considerations can further limit access. Insurance and pharmaceutical company support may not fully cover the costs associated with treatment, while finding a caregiver can also be difficult. Although requirements for patients to remain within a certain distance of treatment centers have been relaxed in some cases, geographic and financial barriers continue to prevent some patients from pursuing CAR T-cell therapy.

Another challenge is the time required to complete the CAR T-cell process. Scheduling apheresis, manufacturing the cells, and ultimately administering the treatment can take several weeks, with the interval from referral to infusion sometimes reaching 2 months or longer. For patients with rapidly progressing disease, that delay may not be feasible.

Careful planning is therefore essential, including determining how to control the disease before apheresis and whether bridging therapy is needed between apheresis and CAR T-cell infusion.

“For patients who are not able to wait, bispecific antibody combinations can be a good alternative,” Seshadri said. Expanding access and improving coordination between academic centers and community oncology practices could help make CAR T-cell therapy more feasible for a broader range of patients.