Implications of Expanding Use of CAR T-Cell Therapy in Relapsed/Refractory Non-Hodgkin Lymphoma (NHL) - Episode 12
Jeff Sharman, MD, provides insight on provider engagement in terms of outpatient CAR T education and thoughts on partnering with CAR T manufacturers in this setting.
Jeff Sharman, MD: Within my own program, the start-up training to get engaged in CAR [chimeric antigen receptor] T therapy was quite extensive. We carved out a subdivision of our medical oncology program for those individual providers who were interested in taking on this additional layer of complexity in their practice. Each team and every member was educated regarding management of adverse effects, patient selection, prognostication, and so forth. Beyond that, we also undertook efforts and provided education to the multidisciplinary providers who will be seeing these patients in the hospital when those patients are hospitalized for adverse effects. That included ER [emergency department] pulmonary critical care, cardiology, and neurology. There’s a familiarity that is cross-disciplinary for the eventual certainty that some of these patients will be admitted and will require the assistance of those additional physicians.
In addition to those providers, there were efforts to educate nursing. In our own hospital, these patients would be triaged to the oncology ward where those nurses have received training. In addition, we have what’s called a rapid-response team, and that rapid-response team triages patients who are having acute deteriorations in their clinical care. Those providers are always instantly available to a deteriorating patient. It’s not only the physicians but also the associated nursing staff who have been educated.
There are 2 aspects in which partnering with the manufacturers during the rollout of these therapies is going to be most important. The first is going to be about payers. As we approach the payers in our own marketplace who are already, these payers are understandably going to be having a high level of scrutiny with novel therapeutics that are associated with the price tag that many of these cellular therapies are. There’s going to be a high level of scrutiny and partnering with the manufacturer regarding payer education, and that support in negotiation is going to be essential. And on the medical side as well, having access to those medical monitors or the medical science team from the manufacturer who can support during some of the early experience with CAR T, making sure we’re troubleshooting any management algorithms that we have and having that familiarity and access for questions will be helpful.