Dr Battiwalla on Limitations to CAR T-Cell Therapy Access in Hematologic Malignancies

Minoo Battiwalla, MD, MS, director, Blood Cancer Outcomes Research, Sarah Cannon Research Institute, TriStar Medical Group, discusses both the benefits and the limitations of treatment with CAR T-cell therapy in patients with non-Hodgkinlymphoma (NHL) and multiple myeloma. He also highlights the safety profiles and financial toxicities that are associated with with this effective treatment option.

CAR T-cell therapy has demonstrated significant effectiveness in various indications, such as NHL and multiple myeloma, Battiwalla states. However, the primary challenge surrounding CAR T-cell therapy lies in managing patient access, he emphasizes, noting that this access is often restricted for several reasons.

First, the substantial cost associated with this treatment necessitates a comprehensive evaluation prior to administration, he begins. This financial burden can limit patient access to therapy, according to Battiwalla, who adds that the risk of severe toxicity is another critical factor. As the administration of CAR T-cell therapies expands beyond specialized transplant centers, hematologists are concerned about treating patients who may experience unexpectedly high levels of toxicity, Battiwalla reports. These toxicities, including high-grade cytokine release syndrome and neurotoxicity, require immediate intervention and can be particularly alarming for non-specialized health care facilities, he says. Currently, no commercially available CAR T-cell therapies are adequately prepared for broader community application, Battiwalla continues.

Furthermore, there is often a prolonged wait time between when patients are initially referred for treatment and when they receive therapy, he reports. Although this duration has decreased due to more efficient intake processes, it remains a significant barrier, especially for patients with aggressive variants of large cell lymphoma who cannot afford to delay treatment, he continues. In this context, the careful selection of bridging and continuation therapies to expedite patient access to CAR T-cell therapy is essential, Battiwalla emphasizes. This process demands substantial effort and coordination between referring community oncologists and treating transplantcenters, he says. The access barriers for these highly effective therapies present a considerable challenge within the field, Battiwalla concludes.