Title: Overcoming Barriers in Access to CAR T Cell Therapy for Blood Cancers: A Promising Future
Introduction:
CAR T cell therapy has emerged as a highly effective treatment option for blood cancers like leukemia. However, access to this innovative therapy remains a challenge for many patients due to high costs and limited availability. This article explores the barriers patients face in accessing CAR T cell therapy and highlights programs that provide financial support. Furthermore, it delves into the science behind CAR T cell therapy, its success rates, potential side effects, and the ongoing efforts to improve its effectiveness and reduce adverse reactions.
Expanding Access to CAR T Cell Therapy:
– Limited availability: Currently, only about 100 cancer centers in the United States offer CAR T cell therapy, making it difficult for patients to access the treatment.
– Travel and accommodation costs: Patients often have to travel to these specialized centers, which adds to the financial burden.
– Expensive treatment: The high cost of CAR T cell therapy, which can reach $500,000 per treatment, creates a significant barrier for patients without insurance coverage or Medicare.
– Additional costs: In addition to the therapy itself, patients may incur expenses for necessary chemotherapy and potential side effects.
Programs to Help Patients:
– Insurance authorization: Patients can avoid unnecessary bills by obtaining authorization from their insurance company before undergoing scans or procedures related to CAR T cell therapy.
– Uncompensated care program: MD Anderson Cancer Center provides unpaid care for eligible patients who meet certain financial criteria. In fiscal year 2021, MD Anderson offered $317.5 million in such care to over 77,000 patients.
The Science behind CAR T Cell Therapy:
– CAR T cells as “living drugs”: CAR T cells are derived from a patient’s own immune system, modified in a laboratory to target and destroy cancer cells.
– Infusion process and preparation: Large numbers of modified T cells are created and infused back into the patient after chemotherapy to weaken their immune system.
– Potential side effects: CAR T cell therapy can cause cytokine release syndrome, fever, nausea, headaches, and other neurological changes. Ongoing efforts focus on refining the therapy to minimize side effects.
The Evolving Landscape of CAR T Cell Therapy:
– Expanded eligibility: Previously, patients had to undergo multiple rounds of traditional cancer therapy before being considered for CAR T cell therapy. Now, patients with disease relapse within 12 months can be considered as candidates for CAR T therapy.
– Clinical trials and approvals: Since the FDA’s approval of the first CAR T therapy for leukemia in 2017, five additional CAR T therapies have been approved for various blood cancers, including lymphomas and multiple myeloma.
– Success rates and remission: CAR T cell therapy has achieved a 60% success rate in inducing remission in patients. Long-term follow-up studies are underway to assess the durability of these responses.
Advancing CAR T Cell Therapy:
– CARTOX app: MD Anderson’s app, CARTOX, helps rate the severity of side effects in CAR T cell therapy patients and recommends appropriate treatments.
– Reducing toxicity: Efforts are underway to lessen the toxicity of CAR T cell therapy by exploring new antigens, using T cells from one patient to help another, and combining CAR T sequencing with chemotherapy or other treatments.
– Future innovation: The field of CAR T cell therapy continues to evolve, presenting opportunities for further advancements in treatment efficacy and patient care.
A Promising Future for CAR T Cell Therapy:
– Despite the barriers and challenges, CAR T cell therapy offers immense potential in the treatment of blood cancers.
– Ongoing research and innovation aim to improve the therapy’s effectiveness, reduce side effects, and expand access to a broader patient population.
– Collaboration between healthcare providers, researchers, and pharmaceutical companies will play a crucial role in realizing the full potential of CAR T cell therapy.
Summary:
CAR T cell therapy has revolutionized the treatment of blood cancers, but barriers such as high costs and limited availability persist. However, programs and initiatives are helping patients overcome these challenges, offering financial support and assistance. Ongoing research and technological advancements are aimed at optimizing CAR T cell therapy, reducing side effects, and expanding access to patients. With promising success rates and continuous innovation, CAR T cell therapy holds tremendous potential in the fight against blood cancers, offering hope for improved outcomes and a brighter future for patients.
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June 22, 2023 – CAR T cell therapy is a relatively new and extremely effective treatment for blood cancers such as leukemia. That is, if you can get it. For many, the drugs are too expensive to afford without insurance coverage, and treatment requires access to the few hospitals that offer the therapy.
The barriers are especially uneven because drugs are now in “the frontline setting” of successful treatment options, said Sairah Ahmed, MD, a lymphoma and myeloma specialist at the University of Texas MD Anderson Cancer Center.
CAR T cells are described by the National Cancer Institute as a “living drug,” in which T cells from a patient’s own immune system are harvested and modified in a laboratory to bind to and kill cancer cells. Large numbers of cells are created and then infused back into the patient. The infusion process takes just one hour, before which the patient receives chemotherapy to weaken their immune system and prepare it for the ingestion and proliferation of CAR T cells.
Ahmed, who directs the CAR T cell therapy program at MD Anderson, said each CAR The T cell product can cost $500,000 out of pocket without insurance or Medicare. Other costs include the necessary chemotherapy, along with the burden of potential side effects.
However, there are programs to help. According to the M.D. Anderson website, patients can avoid unnecessary bills by getting authorization from their insurance company before getting a scan. Additionally, for patients who are US citizens and legal residents of Texas, and who fall into the limited financial asset or low income category, MD Anderson provides unpaid care. In fiscal year 2021MD Anderson provided $317.5 million in such care for more than 77,000 patients.
Only about 100 cancer centers in the United States are equipped to use the treatment, making access and travel costs difficult for many patients. A CAR T therapy patient would also need to stay at the CAR T cell center after receiving the cells.
“There may be some kind of resources for certain groups to mitigate some of that cost,” Ahmed said. “But at the end of the day, it’s the patient’s family that takes care of that.”
“I think there are multiple barriers, socioeconomically. And I think there are some centers that have the resources to help patients with some of those costs,” she said. “But certainly, even in the best kind of resource-rich environment, we can’t completely mitigate that cost to a patient.”
In 2015, MD Anderson launched its first CAR T-cell therapy clinical trial, seeing hundreds of patients. The FDA approved CAR T-cell therapy for leukemia in 2017 with the first product called Kymriah, from the pharmaceutical company Novartis. Since then, the FDA has approved five other CAR T therapies, all designed to treat blood cancers, from different forms of leukemia to lymphomas and, most recently, multiple myeloma.
Jeremiah Bergeron, a CAR T-cell therapy nurse, said the success rate for patients who achieve remission is 60%. Side effects, which can be serious, range from fever to neurological changes. In many cases, he said, the patient may have cytokine release syndrome, when the redesigned cells that are infused into the patient’s body attack their own cells, which can cause fever, nausea, headaches, rash, pounding rapid heartbeat, low blood pressure and problems. breathing.
“We make [take] conservative measures, but if it starts to [cause] difficulty breathing, we’ll give you oxygen. We will give him medication so that it can be used to slow down the CAR T,” Bergeron said.
‘exciting moment’
Initially, a patient would have to go through two rounds of more traditional cancer therapy before being approved for CAR T therapy. But in the last 2 years, Ahmed said, a patient who has only received one prior treatment may consider the treatment with CAR T-cell therapy.
“For patients who have disease that has relapsed within 12 months, CAR T-cell therapy is the preferred treatment option, and it is treatment with curative intent,” he said. Ongoing clinical trials using CAR T therapy as the first treatment for large cell lymphoma have also expanded eligible patient populations.
Several things determine the side effects and negative reactions of patients using CAR T therapy. Ahmed said those include the patient’s age and their health prior to receiving the therapy.
MD Anderson advanced practice nurse Sherry Adkins created an app called CARTOX that works to rate the severity of a patient’s side effects and link them to the best treatment.
Ahmed said that doctors look at various factors and make nuanced recommendations for patients based on their risks. “So potentially finding ways to lessen the toxicity is a way to go because it looks like the treatment is still really effective — it works well,” he said. “We just have to make it work without having so many side effects.”
“You want to have something that’s right in front of your face and be able to quickly connect what the symptoms are and then what you need to do,” Ahmed said. “So that’s really instrumental.”
She thinks there are several potential avenues for refining CAR T cell therapy in the future, including research into targeting other antigens, using T cells from one patient to help another, and CAR T sequencing with chemotherapy or other treatments.
“I think there is still a lot of room for innovation and for the next steps,” Ahmed said. “But you know, this is a really exciting time to be a cell therapy doctor right now.”
https://www.webmd.com/cancer/lymphoma/news/20230622/car-t-cancer-therapy-can-be-lifesaving-if-you-can-afford-it?src=RSS_PUBLIC
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