Survey Identifies Obstacles to Adoption of CAR T-Cell Therapy for DLBCL

Bruce Feinberg, DO, discusses a survey researching chimeric antigen receptor T-cell therapy’s growing usage by community oncologists for diffuse large B-cell lymphoma.

Bruce Feinberg, DO, vice president and chief medical officer of Cardinal Health Specialty Solutions, discusses a survey researching chimeric antigen receptor (CAR) T-cell therapy’s growing usage by community oncologists for diffuse large B-cell lymphoma (DLBCL).

The results of this survey of community oncologists have shown there are still obstacles to the adoption of CAR T-cell therapy, Feinberg says. The survey explored factors such as rate at which oncologists now use CAR T-cell therapy, their perceptions of the therapy, and what barriers they face in getting patients this treatment.

In addition, they surveyed specialists at tertiary care centers who observed that CAR-T cell therapy is underutilized due to barriers in accessing treatment. One particular barrier is that patients who are referred to receive therapy have advanced disease and cannot afford to wait 6 weeks from referral to the start of CAR T-cell administration. Another barrier is that other types of therapies have been introduced in the relapsed/refractory setting of diseases where CAR T-cell therapy is approved, causing confusion about when community oncologists should consider referring patients for CAR T cell therapy.

In addition, the phase ZUMA-7 trial (NCT03391466) showed that axicabtagene ciloleucel (Yescarta) CAR T-cell therapy was superior to autologous stem cell transplant (ASCT) as a salvage therapy for relapsed/refractory DLBCL, making it important that community oncologists are prepared to refer patients for CAR T-cell therapy earlier. With these changes in therapeutic sequencing, Feinberg says it is critical for physicians to keep up and become more comfortable with using new therapies.


0:08 | We're trending that rate of adoption, that perceptions of physicians, the perceived barriers they find. And we're not just doing that assessment of physicians in the community, but we're also gathering experts from the major tertiary care centers to understand what they're perceiving as barriers and [got] a general sense that CAR T-cell therapy currently is underutilized for those reasons and those barriers.

What we find is there are still problems. The patients undergoing CAR T therapy have advanced disease; these patients are not clinically stable. The current timeline for CAR T-cell [therapy], which can take 6 weeks from point of referral to point of CAR T-[cell] administration, often is problematic because of that patient instability. And then there has a host of new therapies which entered the armamentarium of treating physicians, which are making it confusing as to which is the appropriate second-line, third-line treatment.

1:08 | Recent data from the ZUMA-7 trial [have] demonstrated that CAR T-cell [therapy] is a more effective therapy than ASCT as the first salvage treatment. And that also adds a dynamic so that when we're doing this research, it can't be viewed as static. We have to be viewing it as a need for recurrent evaluations, as therapy indications change, as new therapies come online. So part of the basis for this research is really to be able to constantly trend what's happening in the field of newer therapies and how physicians perceive those new therapies and what are the outcomes of the patients they're referring for those therapies? That was the focus of the work we recently have done in DLBCL.

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