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Bringing CAR T-Cell Therapies to Community Oncology Overview

Until recently, chimeric antigen receptor (CAR) T cell (CAR T) therapies have generally been restricted to small clinical trials. But since the first two CAR T-cell therapies were approved by the FDA in 2017, CAR T therapy has moved beyond the lab, and it is now successfully delivered in cancer programs and practices large and small across the country. The breakthroughs realized by this therapy have produced remarkable responses in some patients for whom other treatments had stopped working, leading to significant enthusiasm for the potential of CAR T-cell therapy beyond the blood cancers for which it is currently approved to treat. More than 600 active CAR T-cell therapy trials are currently ongoing worldwide.

But because the application of immunotherapy requires skills and infrastructure not necessitated by traditional cancer therapies, there is a wariness among lesser-resourced cancer programs and practices to offer CAR T-cell therapy. Many smaller community cancer programs cite multiple reasons for why they prefer to refer patients who are candidates for CAR T-cell therapy to larger cancer practices and academic medical centers. These reasons include unfamiliarity with the therapy; inadequate reimbursement for steep costs; insufficient infrastructure; and the potential for unfamiliar life-threatening toxicities in patients. In a series of surveys in 2016 and 2017, of nearly 400 U.S. community oncologists/hematologists and practice administrators representing a diverse mix of practice types and geographic regions, 64 percent said the biggest barrier they face to successfully implementing CART T-cell therapy is the logistics involved in administering treatment and patient follow-up.

This project aims to help community cancer programs and practices of all sizes acquire the education and tools they need to offer CAR T-cell therapy close to where their patients live. To accomplish this, the project will: 1) help local cancer programs and practices build the knowledge and skills required to offer safe CAR T-cell therapy, 2) teach practices how to help their patients overcome costs barriers, and 3) help build the operational infrastructure (e.g., care coordination and patient support) required for a successful program.

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This educational project is supported by Janssen Oncology.