Understanding Barriers to CAR T-Cell Therapy for Blood Cancer Patients

If myeloma, lymphoma, or leukemia patients are referred to receive CAR T-cell therapy, what barriers are keeping them from receiving it? 

Yannis Valtis, MD, a Chief Fellow at Memorial Sloan Kettering Cancer Center, led research efforts to evaluate these barriers. The study’s findings were discussed at the 2024 ASH conference. 

Watch Dr. Valtis’ interview on barriers to CAR T-cell therapy below and continue reading for a summary of his important research.

6 Barriers to Receiving CAR T-Cell Therapy 

Out of 400 blood cancer patients (myeloma, lymphoma, and leukemia) referred to receive CAR T-cell therapy, 44% of these patients ended up not getting the treatment. 

What happened? 

From Dr. Valtis’ research, the reasons patients did not receive CAR T-cell therapy included:  

1. Cancer Progressed Too Quickly:

   • CAR T-cell therapy made from a patient’s own T-cells takes several weeks to make. The top reason why patients didn’t receive the treatment was because the cancer progressed too quickly before the therapy was ready. 

2. Treatment Shortage or No Clinical Trial Available:

   • The second reason patients didn’t receive their scheduled CAR T-cell therapy was that the treatments were not available or that patients couldn’t access the therapy in a clinical trial. 

3. Concerns About Side Effects:

   • The third reason blood cancer patients didn’t receive CAR T-cell therapy was because either they or their doctor had concerns about side effects and decided to withdraw. 

4. No Immediate Need for Therapy:

   • Some patients were referred when the cancer was stable or in remission, so they did not need the treatment. 

5. Logistical Issues:

   • Many patients faced difficulties with logistical issues, such as needing to relocate or not having a caregiver.
6. Other Reasons:

   • A few patients and doctors were concerned about whether the treatment would work.

   • Some patients could not receive the treatment due to manufacturing problems. 

Additional insights from the study mentioned that patients with lymphoma were more likely to receive the therapy than those with myeloma. 

Also, Black patients were less likely to receive the treatment compared to White patients, even when considering their type of cancer.

Possible Solutions

To help more patients receive CAR T-cell therapy, possible improvements could include: 

1. Early Referrals
   • Referring patients earlier for CAR T-cell therapy could support enough preparation time for treatment before the cancer worsens.
2. Faster Treatment Options
   • Researchers are developing ready-to-use CAR T-cells, also known as “off-the-shelf” CAR T-cell therapy from donors. This could help remove the delay period for patients who need a fast turnaround. 
3. Improved Patient and Doctor Education
   • More information could help patients and doctors decide sooner and understand the risks and benefits of CAR T-cell therapy. 
4. Addressing Racial Disparities
   • Further studies are needed to understand and remove barriers that prevent Black patients from receiving CAR T-cell therapy.

Conclusion

CAR T-cell therapy is a promising treatment for blood cancer patients, but not everyone who is referred can receive it. The most common barriers include the cancer progressing too fast, the treatment is not available, and concerns about side effects.

By referring patients earlier, developing “off-the-shelf” treatment options, educating about side effect management, and addressing logistical challenges, more patients could benefit from CAR T-cell therapy. 

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Sources: 

• Barriers to Immune Effector Cell Therapy: Rapid Disease Progression, Concern for Toxicity, and Lack of Appropriate Trials Drive Non-Receipt after Referral at a Large Academic Center
• Exploring Barriers to CAR T-Cell Therapy in Blood Cancer Patients