{"title":"CAR T-cell therapy: A collaboration between authorized treatment centers and community oncologists","authors":"","doi":"10.1053/j.seminoncol.2024.02.001","DOIUrl":null,"url":null,"abstract":"<div><p>With the approval of the first CAR T-cell products for hematological malignancies in 2017, these autologous cell therapies have changed the treatment paradigm for patients with relapsed or refractory (r/r) non-Hodgkin lymphoma (NHL), who have a poor prognosis and few effective treatment options. Despite the demonstrated clinical benefit in patients with r/r diffuse large B-cell lymphoma, mantle cell lymphoma, and follicular lymphoma, many patients who are eligible for CAR T-cell therapies do not receive them or are treated with CAR T cells as a later line of therapy at advanced stages of disease. Several barriers exist for referring patients to an authorized treatment center (ATC) for CAR T-cell therapy. Although most patients with NHL are treated by community-based oncologists, educational gaps may exist for some community oncologists about the availability of CAR T-cell therapies in certain indications, the overall treatment process, and how they can access these therapies for their patients. In addition to navigation of the referral process from the community setting to the ATC, other barriers include timely identification of candidates eligible for CAR T-cell therapy and logistical and reimbursement concerns. Here, we examine the patient CAR T-cell experience, which begins and ends in the community setting, and identify and discuss opportunities for improved collaboration between community oncologists and ATC physicians to help address barriers to treatment and enhance patient outcomes. Treatment decisions for a patient's second or third line of therapy for NHL are critically important, owing to declining probabilities for favorable outcomes with each successive line of therapy. For patients who are eligible, CAR T-cell therapies should be considered as early as possible in their treatment course. A better understanding of the CAR T-cell process, the patient's experience, and the collaboration necessary for timely patient identification, better access, and successful outcomes will enable more patients to benefit from CAR T-cell therapies.</p></div>","PeriodicalId":21750,"journal":{"name":"Seminars in oncology","volume":null,"pages":null},"PeriodicalIF":3.0000,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0093775424000046/pdfft?md5=37592ae048944580f3ea166540526d16&pid=1-s2.0-S0093775424000046-main.pdf","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Seminars in oncology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0093775424000046","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ONCOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
With the approval of the first CAR T-cell products for hematological malignancies in 2017, these autologous cell therapies have changed the treatment paradigm for patients with relapsed or refractory (r/r) non-Hodgkin lymphoma (NHL), who have a poor prognosis and few effective treatment options. Despite the demonstrated clinical benefit in patients with r/r diffuse large B-cell lymphoma, mantle cell lymphoma, and follicular lymphoma, many patients who are eligible for CAR T-cell therapies do not receive them or are treated with CAR T cells as a later line of therapy at advanced stages of disease. Several barriers exist for referring patients to an authorized treatment center (ATC) for CAR T-cell therapy. Although most patients with NHL are treated by community-based oncologists, educational gaps may exist for some community oncologists about the availability of CAR T-cell therapies in certain indications, the overall treatment process, and how they can access these therapies for their patients. In addition to navigation of the referral process from the community setting to the ATC, other barriers include timely identification of candidates eligible for CAR T-cell therapy and logistical and reimbursement concerns. Here, we examine the patient CAR T-cell experience, which begins and ends in the community setting, and identify and discuss opportunities for improved collaboration between community oncologists and ATC physicians to help address barriers to treatment and enhance patient outcomes. Treatment decisions for a patient's second or third line of therapy for NHL are critically important, owing to declining probabilities for favorable outcomes with each successive line of therapy. For patients who are eligible, CAR T-cell therapies should be considered as early as possible in their treatment course. A better understanding of the CAR T-cell process, the patient's experience, and the collaboration necessary for timely patient identification, better access, and successful outcomes will enable more patients to benefit from CAR T-cell therapies.
随着 2017 年首批治疗血液恶性肿瘤的 CAR T 细胞产品获得批准,这些自体细胞疗法改变了复发或难治性(r/r)非霍奇金淋巴瘤(NHL)患者的治疗模式,这些患者预后较差,有效的治疗方案很少。尽管R/R弥漫大B细胞淋巴瘤、套细胞淋巴瘤和滤泡淋巴瘤患者的临床获益已得到证实,但许多符合CAR T细胞疗法条件的患者并没有接受这种疗法,或在疾病晚期才接受CAR T细胞作为后期疗法。将患者转介到授权治疗中心(ATC)接受 CAR T 细胞疗法存在一些障碍。虽然大多数 NHL 患者都是由社区肿瘤学家治疗的,但对于某些社区肿瘤学家来说,在 CAR T 细胞疗法在某些适应症中的可用性、整体治疗流程以及如何为患者获得这些疗法等方面可能存在教育差距。除了从社区环境到 ATC 的转诊流程之外,其他障碍还包括及时发现符合 CAR T 细胞疗法条件的候选者以及后勤和报销问题。在此,我们研究了患者在社区环境中开始和结束 CAR T 细胞治疗的经历,并确定和讨论了改善社区肿瘤学家和 ATC 医生之间合作的机会,以帮助解决治疗障碍和提高患者疗效。患者接受 NHL 二线或三线治疗的治疗决策至关重要,因为随着治疗线的不断延长,患者获得良好治疗效果的概率也在不断下降。对于符合条件的患者,应在治疗过程中尽早考虑 CAR T 细胞疗法。更好地了解CAR T细胞治疗过程、患者的经历以及及时发现患者、更好地获得治疗和成功治疗所需的合作,将使更多患者受益于CAR T细胞疗法。
期刊介绍:
Seminars in Oncology brings you current, authoritative, and practical reviews of developments in the etiology, diagnosis and management of cancer. Each issue examines topics of clinical importance, with an emphasis on providing both the basic knowledge needed to better understand a topic as well as evidence-based opinions from leaders in the field. Seminars in Oncology also seeks to be a venue for sharing a diversity of opinions including those that might be considered "outside the box". We welcome a healthy and respectful exchange of opinions and urge you to approach us with your insights as well as suggestions of topics that you deem worthy of coverage. By helping the reader understand the basic biology and the therapy of cancer as they learn the nuances from experts, all in a journal that encourages the exchange of ideas we aim to help move the treatment of cancer forward.