The Path Forward for Community CAR T-Cell Therapy

"The Path Forward for Community CAR T-Cell Therapy Access" closes the series with Dr. Porter's assessment of the access gap and what a durable solution requires.

Dr. Porter closes the series with a blunt assessment of the scale of the access problem. He cites data suggesting only about 18% to 20% of patients who should be eligible for CAR T-cell therapy ever actually receive it, calling that gap simply unacceptable. He believes the only way to meaningfully close it is to bring these therapies to where patients live.

That belief, he says, is increasingly supported by data. His own community sites and other centers nationally show community-based CAR T-cell therapy delivering results comparable to academic care, and he points back to the earlier ASCO findings on non-FACT-accredited centers as further evidence. He is careful to separate two overlapping but distinct categories: non-FACT-accredited status and community location are not the same thing, even though much of the non-accredited experience currently sits in community settings.

Dissemination has to be intentional, Dr. Porter cautions. Not every site, hospital, or physician practice should offer CAR T-cell therapy; the right infrastructure and institutional commitment still matter. Wherever it happens, he says programs need a mechanism to define what high quality means, help sites build toward it, and then monitor and measure it over time. He credits FACT with serving that function today, having redesigned its standards specifically to be more accessible to community sites.

Still, Dr. Porter is clear that FACT itself is not the point; it simply happens to be the accreditation body the field has relied on for years. What matters is choosing some mechanism that protects patient safety and outcomes, whatever form it takes. He expects FACT to keep evolving to stay logical and accessible for sites bringing CAR T-cell therapy to their communities, while adding that other quality mechanisms could eventually play that same role.

The final episode in this series, "Achieving Equitable Community CAR T-Cell Access," closes with what practices, payers, and policymakers can do next.