Real-World Survival Impact of CAR T Therapy in Advanced DLBCL: Findings From a SEER Database Analysis: Part 2
Key Clinical Summary
- Expanding equitable access to chimeric antigen receptor (CAR) T therapy requires standardized referral pathways, stronger collaboration between community oncologists and academic centers, and broader availability of CAR T programs.
- Clinicians must balance CAR T’s survival benefits with risks such as cytokine release syndrome and neurotoxicity through careful patient selection, multidisciplinary care, and standardized toxicity monitoring protocols.
- Ongoing efforts to improve outpatient CAR T delivery, increase clinical trial diversity, and address financial and transportation barriers may help extend access to underserved patient populations.
In Part 2 of our interview with Nishanth Thalambedu, MD, the discussion turns to the practical challenges of expanding CAR T therapy access and integrating it into standard lymphoma care. Building on findings from the study, “Impact of the CAR-T Era on Survival in Diffuse Large B-Cell Lymphoma: A U.S. Population-Based Cohort Study,” Dr Thalambedu examines barriers including referral pathways, treatment accessibility, toxicity management, and disparities in care. The conversation also explores strategies for improving equitable access to CAR T therapy and balancing its survival benefits with the complexities of treatment delivery across different clinical settings.
With persistent racial and demographic differences observed across cohorts, what strategies should oncology teams and health care systems implement to ensure equitable access to CAR T therapy within clinical pathways?
Nishanth Thalambedu, MD: To ensure access to CAR T for all patients, oncologists should have a standard referral pathway, even in community oncology. For example, when a patient with DLBCL has progressed on first-line chemotherapy, they should have a standard pathway to refer the patient for CAR T therapy. This can be achieved by having a strong partnership between a community oncologist and an academic center. So, as soon as a patient has progressed on first-line treatment or when there is a relapse, they can directly refer the patient to the partner academic center.
We're still working on expanding CAR T access to different hospitals to ensure equitable access for all patients. We need to increase the diversity in clinical trials to include different demographic populations as well. In addition, financial and transportation support should be provided because some patients live far from the academic centers where they can get access to the CAR T treatment.
How should clinicians balance the demonstrated survival benefits of CAR T with its known toxicities and resource intensity when designing standardized treatment algorithms for DLBCL across different practice settings?
Dr Thalambedu: Even though CAR T offers survival benefits, it comes with its own complications. The 2 major complications are the cytokine release syndrome (CRS) and neurotoxicity, as shown in the ZUMA and JULIET trials. When balancing these factors, both the toxicities and benefits of CAR T, there are a few things to keep in mind. The first is careful patient selection. For example, patients with inherent neurological issues should be carefully screened before CAR T referral because they may develop neurotoxicity on top of their neurological condition. They should also have multidisciplinary care coordination with a neurologist as the toxicities might outweigh the benefits.
Secondly, community oncology programs should partner with academic centers. When patients receive CAR T therapy, there should be a standard toxicity monitoring protocol in place where the toxicities can be recognized earlier and treated appropriately. That way the patient can still get the benefits while still managing the toxicity.
Recently, we’ve been trying to see if we can provide CAR T treatment in outpatient settings where it is more accessible and can be done on a large scale. By using all these techniques, clinicians can balance CAR T benefits with its toxicities, and more patients can get access to the treatment.
Is there anything else you'd like to add? Any final thoughts or takeaways?
Dr Thalambedu: Since this is a SEER database study, it lacks treatment-specific data, so we cannot directly confirm the CAR T use. However, it suggests that having CAR T approved and using CAR T in the real world significantly contributed to the survival of the patients with DLBCL. And with treatments recently approved and new treatments on the horizon, the treatment landscape of lymphoma is changing and patients are getting more benefits than before.
