Partnerships Power Access to Advanced Oncology Therapies

An Institute for Value-Based Medicine^® (IVBM) evening in Charlotte, North Carolina, on March 31, 2026, centered on pivotal issues related to multistakeholder partnerships in oncology, breakthroughs in oncology care, and adapting protocols, strategies, and therapies to advance patient care. The audience of physicians, pharmacists, shareholders, and managed care professionals engaged panelists in 4 in-depth discussions, prompting thought-provoking conversations that delved into issues such as care delivery and barriers to care.

Building Value Through Multistakeholder Partnerships in Oncology

The first session, moderated by Justin Favaro, MD, PhD, a hematologist and oncologist at Carolina Oncology Specialists, focused on how clinicians can address patients’ needs through different models of care while leveraging multistakeholder relationships. In defining the parameters of these partnerships, Favaro emphasized their potential to save patients and payers money. He illustrated his point through multiple patient cases and the patients’ struggles to afford value-based care.

“These are not local cases, but they’re cases of patient service suffering from financial issues with their health care,” he said.

He pointed out discrepancies in US health care spending that move in tandem with inflation, as well as the impact of high tax rates on patients’ health care costs. “This overtaxation and inflationary spending hurts people at the baseline, and then they have the medical bills on top of that,” Favaro explained. “I want to start that as a baseline and ask, ‘How can we help patients with their financial needs as we talk about value-based care?’”

Thomas “Greg” Knight, MD, a hematologist and oncologist at the Levine Cancer Institute at Atrium Health (Levine), noted that ensuring patients can access care close to their home can help to mitigate health care costs.

“We have all these partnerships with all these organizations, but does that really mean we’re partnering up and aligned for the patient? Are we aligned in care?” Knight asked during the discussion. “It’s not just trying to capture all of the billing but trying to do what’s best for the patient, and what’s best for the patient, generally, is to try to get that care close to home.”

Favaro emphasized that a facility’s ability to deliver a specific subset of care, such as taking blood samples for T-cell therapy, should not be constrained by geographic barriers.

Yet value-based care is patient centered at its core, panelist Seungjean Chai, MD, a medical hematologist specializing in breast and gastrointestinal disease at Levine, said during the panel discussion. To tailor therapies and strategies, our health system must account for the broad spectrum of patients with varying coverage or none at all, he explained. A significant partnership to foster between community oncology and academic practices is one with pharmaceutical companies.

As cost remains a significant barrier in access to care, partnerships across systems, specifically with pharmaceutical companies, community oncology and academic practices, and insurance companies, are a step toward reducing cost barriers for patients.

“One of the partnerships that we’re very proud of with Atrium Health is to partner with pharma and to make a commitment to patients that everyone who needs their treatment is going to get their treatment,” Chair said.

Oncology pharmacists are well positioned to reduce waste and pinpoint value in payer-based, pharmacy-driven initiatives.

“What we’ve seen, obviously, in recent years, is oncology now has biosimilars and being able to put [those medications] into practice, which are oftentimes very payer mediated as to what that’s going to be,” said Donald Moore, PharmD, a hematology and oncology specialty pharmacist at Levine, during the discussion. “That process tends to be driven by pharmacy to hopefully try to keep the headache off [oncologists], but it is something that does help to reduce the cost of care.”

Seeking new partnerships among clinical community practices and academic centers is imperative, especially to prioritize and expand value-based care for patients.

“There are certain pinnacle-type technologies, like cellular therapy, certain advanced surgical techniques, radio pharmaceuticals, that you only get if you have a medical school and things of that sort,” Chai explained. “And then underneath that pyramid is a much broader array of care delivery that starts with community, private practices across the state.”

However, accessing therapies in academic centers isn’t always feasible for patients. Chai explained that there are numerous states and cities with few or no National Cancer Institute (NCI)–designated cancer centers, which are most often affiliated with academic institutions, thereby limiting access to innovative therapies and treatments.

“If you rely on that kind of care delivery, it’s clearly unfair that we have affluent metropolitan areas covered pretty well, but the rest of it we have to figure out,” he said.

Favaro proposed opening tumor boards to engage clinicians in community and academic settings to facilitate communication of strategies and practices that improve patient care outside hospital systems.

Knight concurred with Favaro, asking, “It’s not that we don’t have these amazing drugs or treatments, it’s how do we deliver these drugs and treatments to the vast majority of people?”

Advancing Leukemia and Lymphoma Care Through Early Referral and CAR T-Cell Therapy Access

The second panel, moderated by David Rizzieri, MD, a medical oncologist specializing in lymphoma and leukemia at Novant Health (Novant), discussed recent advancements in leukemia and lymphoma care.

“As part of that, addressing the importance of early referral and the implications for options and sequencing, [we need to ask] what are the best ways to build trust between community practices and academic centers to facilitate the referrals?” Rizzieri asked.

Panelist Nilanjan Ghosh, MD, PhD, chair of the Department of Hematologic Oncology and Blood Disorders at Wake Forest University School of Medicine, started the conversation by addressing the importance of referrals for treatment options for patients with leukemia or lymphoma, specifically for chimeric antigen receptor (CAR) T-cell therapy.

“We’ve done some research for lymphoma patients who were referred for CAR T-cell therapy at our institution and then studied how many of them actually got CAR T-cell therapy,” Ghosh said, “and when we looked at the outcomes of patients who were referred for CAR T-cell therapy but couldn’t get it vs those who received CAR T-cell therapy, there was a huge difference in overall survival.”

Yet, despite the referral incentive, the time between referral and the start of therapy is often too long. Another panelist, Turab Mohammed, MD, a hematologist and oncologist at Novant, emphasized that collaborative partnerships help expedite therapies and treatments for patients.

“From a community perspective, every patient deserves a CAR T-cell therapy [referral] at the outset,” Mohammed said. “We may think that maybe this patient isn’t ready for CAR T-cell therapy at our first review, but I think it’s best for the treating physician in terms of who’s doing CAR T-cell therapy to make that determination.”

“About 30% of patients who are referred for CAR T-cell therapy never make it to progression or provider support,” Matthew Warrick, PharmD, a malignant hematology and cellular therapy clinical pharmacist at Medical University of South Carolina, said during the panel discussion.¹ “But we know it’s important for these patients to get another referral so we can do those therapies.”

Utilizing academic centers for communication and structure is imperative to advancing equitable and efficient patient care, especially for delivering therapies such as CAR T-cell therapy, the panelists noted.

“It’s important that even if the patient is not supposedly ready for CAR T-cell therapy, I think it’s good to get them involved in terms of academic providers, so they can review the case and give alternative treatment options,” Mohammed said. “As a result, maybe at some point, if the patient [becomes] eligible, we can still use that window to do CAR T-cell therapy.”

CAR T-cell therapy is also unique, Ghosh said, as it’s often a onetime therapy and increases overall survival and quality of life. Recent approvals of CAR T-cell therapies and bispecifics have broadened options for patients, allowing clinicians to tailor therapies to each patient while leveraging academic partnerships through consistent communication.

“Knowing that only 2 of 10 patients in the country get CAR T-cell therapy, even if there’s an indication, it just tells me that with this complex decision-making, having an opinion [from] the specialist can help drive the decision-making. Partnering closely with the community to either deliver the treatment closer to home or do the initial treatment and send the patient back is very important,” Ghosh said.

Warrick concluded the session, leaving audiences with the question of how academic and community clinicians and practices can evolve to expand equitable and efficacious access to imperative therapies that would improve patients’ lives.

Evolving Treatment Sequencing and Access in Multiple Myeloma

The third session discussed novel therapies in multiple myeloma. Moderator Raymond Thertulien, MD, a hematology oncologist and stem cell transplant specialist at Novant Health Cancer Institute, addressed sequencing in advanced therapies and challenges in managing toxicity at scale.

Thertulien opened the discussion by urging panelists to expand on the previous panel’s conversation about access-related barriers in the multiple myeloma space.

“How do we overcome [these barriers] so that we can see those patients and set those treatment plans, whether transplant, CAR T-cell therapy, or bispecifics, as novel as these treatments are, moving in earlier and earlier lines?” he questioned.

Two panelists had a common answer to Thertulien’s question: by closing the gap between referral and actual treatment, specifically for patients who may need a hematopoietic stem transplant or CAR T-cell therapy.

Sylvester Homsy, MD, a hematology oncologist at Atrium Health Wake Forest Baptist, emphasized that the increase in progression-free survival (PFS) is sustained with continuity of care.

“And this consolidation phase is called consolidation because without it, at the induction phase, we know that myeloma will come back,” Homsy said, citing the DETERMINATION trial (NCT01208662). “We know that the data from the DETERMINATION trial showed that just by adding [autologous stem cell transplant (ASCT)] to an RVD [Revlimid (lenalidomide), Velcade (bortezomib), and dexamethasone] backbone…you gain 10 to 21 months of PFS” compared with those who did not receive ASCT.²

Moore, who also spoke on this panel, added to Homsy’s statement, emphasizing the importance of stem cell transplant evaluations at larger academic centers like Levine.

“Hopefully there, they’ll at least be plugged in with a myeloma physician who can be there for the lifetime of their disease journey, [and] hopefully they’ll be inducted to receiving CAR T-cell therapy,” he said.

Another challenge to accessing multiple myeloma care is the geographic barriers, said Katelynn Granger, PharmD, PCOP, a myeloma and lymphoma clinical pharmacy specialist at Medical University of South Carolina.

“We’re one of the only NCI-designated cancer centers in the state, and we have a big geographical barrier for our patients who have a hard time even affording to come to our treatment center that’s 2 to 3 hours away,” Granger said.

Thertulien encouraged panelists to expand on access-related barriers and questioned how social determinants of health might contribute to patient-access gaps. Homsy responded, noting that many of his patients are from rural areas and that literacy is a challenge.

“Disparities exist as well in CAR T-cell therapy. We know patients with low income and low socioeconomic status get less access to [this treatment]; patients who live really far away from the CAR T-cell center or a main academic hospital, too. They can’t really relocate because they don’t have support; they also don’t have a lot of education or realization of what they should do,” he said.

Thertulien also pointed out how gaps in communication between academic practices and clinical settings often hinder or delay care, noting that consistent communication may help to streamline patients’ receipt of key therapies and treatments.

“We’ve really tried to work with some community partners and understand what their barriers are going to be, and potentially just accepting [patients] back, understanding that not everyone’s going to have the infrastructure or the ability to handle heuristics, but helping them to demystify some of those adverse events as to when they’re likely to occur. Patients could most likely be very safely referred back to their community-based cancer center for continued dosing,” Moore said in response to Thertulien.

However, there are certain obstacles, such as infrastructure, that clinical practices face when delivering care, Moore emphasized. But, despite limitations, there is still a role for non–T-cell–directed and non–CAR T-cell therapies.

Bispecific Antibodies and BiTEs: Expanding Options in Solid Tumors

Moderator Daniel R. Carrizosa, MD, MS, a hematology oncologist at Atrium Health Wake Forest Baptist Comprehensive Cancer Center, began the discussion by asking panelists to highlight key differences between bispecific therapies for solid tumors and hematologic diseases, including bispecific antibodies and bispecific T-cell engagers (BiTEs).

“We have the T-cell engagers, which are currently used in small cell lung cancer [SCLC]. But we also have bispecific and target 2 inhibitors or 2 areas on the same cells or 2 different cells,” said Mohamed K. Mohamed, MD, PhD, a hematology oncologist at Cone Health Cancer Center, during the panel in response to Carrizosa. “But it’s different from what hematology physicians use.”

Hematology bispecifics often target B-cell maturation antigen in SCLC, as Mohamed explained. There are 2 broad categories of bispecifics. Christopher Ryan Pallas, MD, a hematology oncologist at Atrium Health Wake Forest Baptist, pointed out the key differences in how they’re used and for what.

“We’re talking about pushing solid tumors by specific antibodies, where we’re targeting 2 different antigens, whether that’s to work together…whereas when we’re thinking about it by specific T-cell engagers, we’re talking about trying to introduce a T cell up front to the tumor cell,” Pallas said.

However, in solid tumors, physicians who administer BiTEs are grappling with toxicity management and patient outcomes, said Kaitlyn Schomburg, PharmD, a clinical oncology pharmacist at Cone Health.

“The toxicities are a little different, especially just the few patients who we have had, you aren’t seeing as much cytokine release syndrome, but there is a chance that you are seeing a lot more immune effector cell–associated neurotoxicity syndrome,” Schomburg said.

As solid tumor physicians, like Mohamed, their experience with cell therapy is limited, he explained. He emphasized that their unfamiliarity is not with the drug itself, but with managing the associated toxicities.

“Now I’m having to deal with cellular toxicity that I did not have to before. It’s scary for me at the beginning, [because I have to ask myself] how I’m going to manage this,” he said.

Mohamed also noted that in addition to the solid tumor physicians’ inexperience with these toxicities, there is an institutional gap in infrastructure that hinders their ability to manage the associated toxicities.

“[We’ve] really lost the experienced staff that has been dealing with some of these toxicities, so that when you admit somebody to the hospital, they know how to handle it. You have to start from scratch again, training people,” he said.

Additional barriers to managing hematologic patient care are tied to infrastructure. Schomburg spoke of her experience during residency, where there was no dedicated solid tumor patient group.

“I think that’s also something that kind of is where solid tumor experts are a little more nervous, because you don’t have that site care that built up,” she said. “Hematology does all this. They have all of their workspaces, everything completed, but then you have the solid tumor space where it’s like, OK, are they going to this hospital?”

Carrizosa inquired about the specific care team and personnel needed to successfully operationalize bispecific care within a health system, asking, “How do you convince your hospital that this is a value?”

Schomburg led the response, encouraging more community and academic forums and panel discussions, such as IVBMs, featuring a diverse cast of health care workers ranging from nursing managers to inpatient pharmacists to leadership, including head inpatient and outpatient nursing.

“It was a quite a large group, probably about 40 people, and we would meet for an hour every other week to go through all the things, to figure out where we are, what we’re doing, what we do, and then broke it down into different parts that each person was working on, and then the education outcome as well,” she said.

Bispecific and T-cell engagers are transforming outcomes in solid tumors, but their safe and equitable use depends on proactive education, robust infrastructure, and tight collaboration between academic and community centers.

“I think it is being open to communication again. Think that we all need hand-holding when we start any type of new therapy or any other issue,” Carrizosa said, concluding the discussion. “If we are moving these BiTEs into the community, we’re going to need blueprints.”

References

1. Hu B, Vaidya R, Ahmed F, et al. Real-world analysis of barriers to timely administration of chimeric antigen receptor T cell (CAR T) therapy in diffuse large B-cell lymphoma. Transplant Cell Ther. 2024;30(11):1082.el-1082.e10. doi:10.1016/j.jtct.2024.09.007

2. Richardson PG, Jacobs SJ, Weller EA, et al. Triplet therapy, transplantation, and maintenance until progression in myeloma. N Engl J Med. 2022;387(2):132-147 doi:10.1056/NEJMoa2204925