Evolving Treatment Paradigm of R/R NHL and Outpatient CAR T

Jeff Sharman, MD, shares his perspective on the future for CAR T therapy in the community setting for the treatment of R/R NHL.


Jeff Sharman, MD: It’s important that we police ourselves carefully in this process, and this is not something that can be rolled out to any and every center that has an interest in doing so. It’s going to be high-level sophisticated oncology practices that have both size and resource infrastructure who are able to do this. It isn’t going to be available in every medical community by any means, but we shouldn’t also be so blind as to think that this can exist only in the major academic medical centers. Unfortunately, if we were to do that, many patients whose outcomes could be favorably resolved will simply not have access to therapy.

Community settings can also work with academic centers on this to help identify those patients early in the process because these therapies do take time to be manufactured for an individual patient. Working collaboratively with treating facilities that do have access to CAR [chimeric antigen receptor] T-cell therapy is important, and that’s going to be true whether the treating center is academic or community, but working collaboratively with the CAR T center, so patients’ outcomes can be optimized with regard to access. Because if we get a patient too late in the process, we may not be able to administer CAR T to them. That collaborative relationship is important and needs to be done early on.

The future of CAR T is quite dynamic and exciting, and the reason is we’ve started with acute lymphoblastic leukemia and diffuse large B-cell lymphoma. But now we’ve seen approvals of CAR T products in mantle cell lymphoma. We will see this in the near term in multiple myeloma, third-line follicular lymphoma, possibly chronic lymphocytic leukemia, and other B-cell lymphoproliferative disorders. This is a platform that I’d be a surprised not to see expand to nonhematologic malignancies and some solid tumors. I’ve had patients treated in the context of clinical trials to exactly that end.

This is a paradigm change. We treat cancer with surgery, radiation, and chemotherapy. Over the last handful of years we’ve brought in this additional line of medical intervention, which is immunotherapy. Immunotherapy is such a complex basket of therapeutic interventions, but this immune effector cell strategy, which is represented by CAR T, is going to be yet another treatment modality used for the better outcomes of our patients with these terrible diseases.

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