CAR T-cell therapy is poised to become more accessible in community settings, extending its reach beyond major academic centers, according to Saad Z. Usmani, MD, FACP, MBA, a myeloma specialist and cellular therapist at Memorial Sloan Kettering Cancer Center. This expansion is driven by promising developments in treating solid tumors and the potential for cost reduction as the technology becomes more widespread.
Real-World Efficacy of Ide-Cel
Real-world data from a CIBMTR study involving approximately 600 patients who received idecabtagene vicleucel (ide-cel; Abecma) mirrors the clinical trial results, showing similar rates of cytokine release syndrome and neurologic adverse events. Patients achieving a complete response or better experienced a median progression-free survival consistent with published clinical trials. Even patients previously treated with BCMA-directed therapies, such as bispecific antibodies or antibody-drug conjugates, responded to ide-cel, suggesting that BCMA loss is not a primary resistance mechanism.
CAR T-Cell Therapy in Community Centers
Usmani envisions a future where CAR T-cell therapy is readily available in smaller community centers, driven by the emergence of CAR T-cell therapies for solid tumors like lung and breast cancer. He noted, "All the good things start in hematology and then get expanded to other malignancies. Once you get [options like] a relapsed non–small cell lung cancer CAR T cell, the community hospitals will develop mechanisms to manage those patients and build smaller programs."
Cost and Accessibility
The cost of CAR T-cell therapy is expected to decrease as the technology becomes more accessible, potentially leading to point-of-care treatments. Usmani highlighted that more than half of the CAR T-cell therapies at Memorial Sloan Kettering Cancer Center are experimental solid tumor CAR T cells, indicating a significant shift in the field. He emphasized that community centers, which handle 80% of cancer care, will play a crucial role in managing the increasing volume of patients requiring CAR T-cell therapy.
Quality of Life Improvements
Patients who undergo CAR T-cell therapy often experience a remarkable improvement in their quality of life. According to Usmani, "The QOL of patients after CAR T recovery is quite remarkable. They're not on any maintenance treatment and so, they have really good quality of life. They're just coming in once a month for their laboratory tests and to see every other month and they do fine."
