More Oncologists Are Referring Patients to CAR-T Cell Therapy, While Financial Barriers Remain

As chimeric antigen receptor (CAR)-T cell therapies become more regularly integrated into treatment for certain patients with cancer, challenges, such as payer approvals and complicated administrative processes remain, according to research from Cardinal Health Specialty Solutions.¹

Looking at surveys of over 300 oncologists from the United States between February and April 2021, results from the surveys showed that 60% of participating oncologists believe that CAR T-cell therapy costs are either “reasonable” or “not inappropriate” compared to 39% of patients in a previous study from 2017. Moreover, 91% of oncologists referred at least 1 patient to CAR T-cell therapy over the past year which was up by 54% in 2017 and 71% in 2019.

"The innovative science behind cell therapies like CAR T is transforming the long-term outlook for many cancer patients,” said Heidi Hunter, president of Cardinal Health Specialty Solutions, in a press release. “Our latest research shows that, despite some barriers to access, oncologists are embracing these new therapies and are optimistic about their continued use in the future of oncology care.”

In the previous study from Cardinal Health in 2019, researchers had concluded that there was a need to improve administrative processes and address costs of therapy to make sure patients referred to CAR T-cell therapy were given it in a timely manner.² While these obstacles remain, more patients are being referred to CAR T-cell therapy than in 2019. In February 2019 46% of surveyed physicians said they had not referred any patients for CAR-T cell therapy dropping to 29% of surveyed physicians in November of 2019.

Referrals for CAR T-cell therapy in the oncology setting heavily relies on community oncologists referring patients to larger academic institutions that make up the majority of approved centers for administration of CAR T-cell therapy. This led researchers from Cardinal Health to survey oncologists from geographically diverse locations across the United States. In the 2019 study, researchers saw a significant interest in utilizing the therapy and that over time there was more awareness of data showing success in the utilization of these treatments.

Since the first approval of CAR T-cell therapy for patients with cancer, interest in the use of CAR T cells have only grown with further approvals for axicabtagene ciloleucel (axi-cel; Yescarta) in the treatment of adult patients with relapsed or refractory follicular lymphoma, or in patients with multiple myeloma on idecabtagene vicleucel (ide-cel; formerly bb2121; Abecma). Moreover, these newly approved therapies are starting to become available at major cancer centers like the Seattle Cancer Care Alliance.

However, similar to the 2021 study, physicians still cited administrative and financial challenges as the largest barrier to referring patients to CAR T-cell therapy with 73% of respondents in 2019 saying they prescribed bridging chemotherapy to a patient referred for CAR T-cell therapy due to a delay in obtaining the treatment from the manufacturer. Moreover, 65% reported that the patient’s condition had deteriorated before

“The key takeaways for CAR T centers is to invest in streamlining the intake process and enhance communications regarding clinical decisions, patient progress, and clear follow-up instructions to the referring community hematologist/oncologist. The manufacturers can assist with rapid review and certification of CAR T centers,” researchers wrote at the time.

In the most recent survey researchers asked oncologists about the impact of COVID-19 on oncology and their perceptions of the oncology landscape moving forward. Two-thirds of participants reported delays in routine screenings due to the pandemic, but 89% said they will continue using telemedicine even after the end of the pandemic. However, about 4 in 10 oncologists said it was difficult to perform under a value-based care model in pandemic conditions and only 1 in 4 participants believed the current technologies support success in value-based care.

_References:

_{1. Oncologists have grown more comfortable with CAR-T therapy, research finds. News release. Cardinal Health. June 3, 2021. Accessed June 3, 2021. https://prn.to/3cj4I8a}

_{2. Gajra A, Jeune-Smith Y, Kish J, et al. Perceptions of community hematologists/oncologists on barriers to chimeric antigen receptor T-cell therapy for the treatment of diffuse large B-cell lymphoma. Immunotherapy. 2020;12(10):725-732. doi: 10.2217/imt-2020-0118}