Patient Perspectives: Access to CAR T-Cell Therapy

One of the most revolutionary breakthroughs in cancer care comes from within a patient’s own cells: chimeric antigen receptor (CAR) T-cell therapy, which harnesses the powers of the body’s immune system to hone in on and destroy cancer cells. As the landscape for lymphoma continues to evolve, with highly targeted therapies offering new treatment avenues across the disease’s many subtypes, CAR T-cell therapy remains one of the most innovative immunotherapy options available — and its therapeutic potential is still being realized.

From Trials to Therapy

While the immune system’s cancer-killing capabilities have long been studied, CAR T has proven to be a powerful treatment option for many patients for several years now. While CAR T is being studied for its applications across all types of cancer, its early roots can be found in blood cancer research.

After years of incremental progress and clinical trials, tisagenlecleucel (Kymriah), a CAR T-cell therapy, was first approved as a treatment for acute lymphocytic leukemia in August 2017, followed by axicabtagene ciloleucel (Yescarta), which was approved later that year in October for patients with certain types of relapsed or refractory large B-cell or follicular lymphomas who have had at least two other lines of treatment.

Today, there are even more CAR T-cell therapies available to lymphoma patients approved for an even greater number of subtypes, including brexucabtagene autoleucel (Tecartus) for patients with relapsed or refractory mantle cell lymphoma and lisocabtagene maraleucel (Breyanzi) for patients with relapsed or refractory chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) as well as mantle, follicular, marginal zone, and certain large B-cell lymphomas. Originally approved for leukemia, tisagenlecleucel, the very first FDA-approved CAR T-cell therapy, is now approved for relapsed and refractory large B-cell lymphomas as well.

Our knowledge of the potential therapeutic applications for CAR T continues to grow, thanks to scientists studying the disease through research and clinical trials supported by the Lymphoma Research Foundation. CAR T is being studied as an option not just for new subtypes of lymphoma but also for other blood cancers like multiple myeloma as well as solid tumor cancers and autoimmune diseases such as lupus.

Harnessing the Body’s Lymphoma-Fighting Potential

CAR T-cell therapy taps into the immune cell’s innate offensive capabilities to target and destroy lymphoma cells. The first step for a patient undergoing CAR T is extracting the body’s T cells. They are then sent to a special processing center, where they are genetically
engineered to target the antigens present on a lymphoma cell’s surface.

When these genetically reprogrammed cells are reintroduced to a patient’s immune system in the form of an infusion, they have been trained to target and destroy cells with the lymphoma-specific antigen marker CD19.

CAR T is especially significant for the lymphoma community because of its potential to effectively treat patients whose disease has not responded to more traditional treatments and for the hope it offers those with previously thought incurable diagnoses, such as follicular lymphoma. It also offers durable, long-lasting responses without the long-term side effects of other types of lymphoma treatments like allogeneic stem cell transplants, which can sometimes lead to complications like graft vs. host disease, or high-dose chemotherapies that can be harsh on the body

Carving a Path Forward: The Lymphoma Research Foundation’s CAR T-Cell Stakeholder Summit

For all of the significant advances that CAR T-cell therapy represents, there are also a number of challenges that it faces toward widespread adoption: a dearth of both patient and physician knowledge when compared to more traditional treatments, difficulties with insurance coverage, lack of access to specialized CAR T centers, and lack of awareness of how to manage potential side effects.

The Foundation plans to continue to use its convening power to address gaps in care and areas of critical need in accessing this lifesaving treatment option and to support scientists and groundbreaking research to make the next generation of cures like CAR T-Cell therapy possible.

To that end, the Lymphoma Research Foundation convened the CAR T-cell Therapy Stakeholder Summit in January 2023 to discuss the factors preventing CAR T from reaching its full potential as a therapeutic option and to develop practical solutions for the barriers facing patients, their families, and their physicians. Led by Dr. Caron Jacobson (Dana-Farber Cancer Institute) and Dr. Javier Munoz (Mayo Clinic, Arizona), the Summit aims to improve access to CAR T by improving patient and physician education and access, better connecting physicians with specialized CAR T centers, and working with institutional and industry partners to remove barriers to care.

Together with our partners in research institutions, the pharmaceutical industry, and patient advocacy groups, the Foundation plans to continue to use its convening power to address gaps in care and areas of critical need in accessing this lifesaving treatment option and to support scientists and groundbreaking research to make the next generation of cures like these possible.