CAR T and Bispecifics Pose Different Challenges in Blood Cancer Treatment: Ravi Vij, MD, MBA

CAR T-cell therapies and bispecific antibodies are reshaping the treatment landscape in hematologic malignancies, but each comes with distinct resource and staffing requirements.

In an interview with The American Journal of Managed Care^® (AJMC^®), Ravi Vij, MD, MBA, professor of medicine in the Division of Medical Oncology at Washington University School of Medicine, explained why CAR T-cell therapy remains far more complex to deliver than bispecific antibodies, particularly in community care settings.

He also explored how newer technologies, such as allogeneic and in vivo CAR Ts, may offer advantages in availability and scalability but still face questions around efficacy, infection risk, and long-term feasibility. Vij said although innovation could broaden access, managing toxicities like cytokine release syndrome (CRS) and neurotoxicity will remain central to safe implementation.

This transcript has been lightly edited; captions were auto-generated.

Transcript

What are the biggest differences in resources and staffing needs when giving CAR T vs bispecific therapies, and how do those differences affect treatment?

Certainly, CAR Ts are much more logistically challenging than bispecifics. They require the capacity to have a phoresis unit to collect the T cells; you need to have a cryopreservation facility to receive the CAR T-cells. Also, the training of the nurses and the ancillary staff is a little more stringent because the risk for higher-grade CRS and neurotoxicity is higher. I think that whereas some day, the average community physician can possibly give their bispecifics even during the ramp-up phase in the community, to transfer CAR T to the community setting, the routine community doctor may be a little bit challenging.

How could newer CAR T technologies change patient access, and what new hurdles might they create?

Certainly, there are new technologies in development to improve upon CAR Ts. The allo CAR T, which is off-the-shelf CAR T, are behind auto CAR Ts in their development, but currently trials are ongoing in a variety of disease states, and hopefully we will have one available in the future. They have the advantage of being off-the-shelf, but most of the data at the moment suggest that these are somewhat less effective, potentially, than the autologous CAR T and they also could potentially have a greater risk for infections, especially if higher doses of chemotherapy are given for lymphodepletion purposes.

I think that the advantage of the allo CAR T is ready availability, so even patients who are progressing and can't wait long enough for CAR T manufacturing can get it. However, the kind of logistics you need to manage CRS and neurological toxicity probably is not too different. In vivo CAR Ts are much further behind in development, and only very early phase trials have started, and it is certainly a technology that could come to fruition in the future.

It is too early to say, but that may be a technology that, depending on how patients tolerate them, could potentially be more scalable even to community settings, but I think it is too early to tell.