Resource Demands Challenge Community Oncology: Christos Vaklavas, MD

In the second and final part of his interview at last week’s Institute for Value-Based Medicine® event in Salt Lake City, Utah, Christos Vaklavas, MD, addressed the growing complexity of running clinical trials at community centers and shared his outlook on how treatment delivery for resource-intensive therapies is likely to evolve.

He explained that clinical trials have become increasingly specialized, requiring centers to build out substantial logistical and regulatory infrastructure, including study coordinators and staff to oversee protocols. For centers with only 1 or 2 trials available, that level of investment is not often worthwhile, Vaklavas said. As a result, certain trial types, such as long-term follow-up studies and later-phase trials, tend to be more feasible to run at community sites.

He also pointed to central institutional review board approval as one mechanism that can reduce administrative burden. For example, a protocol approved by Huntsman Cancer Institute may not require separate approval at local centers. Still, Vaklavas emphasized that the underlying infrastructure demands remain significant, and local centers must be willing to take on that commitment.

Regarding treatment delivery, he discussed the tension between innovation and accessibility for high-resource therapies like chimeric antigen receptor (CAR) T-cell therapy and radiopharmaceuticals. Institutions bear responsibility for ensuring these complex treatments justify the investment required to deliver them, Vaklavas noted.

Looking ahead, he said CAR T-cell therapies are unlikely to see broad adoption in common malignancies such as breast and prostate cancer, given the intensive commitment and resource mobilization they require. Instead, Vaklavas concluded that he anticipates a strong push toward at-home treatment options, such as oral medications and subcutaneous formulations, which patients can administer without a facility visit.

“…their adoption is going to suffer for the very eloquent barriers that you have articulated: the access, the commitment, and the resources that have to be mobilized to make those treatments accessible to patients are just enormous,” he said.