Bruce A Feinberg, DO, and Chadi Nabhan, MD, MBA, FACP, Cardinal Health Specialty Solutions (Dublin, OH), offer a counterpoint to previously detailed concerns regarding newly approved chimeric antigen receptor (CAR) T-cell therapies.
In his opinion piece, Dr Wong raises valid concerns regarding newly approved CAR-T therapies. Barriers to adoption are both numerous and complex, as we previously outlined in our recent paper, “Community Oncologists’ Perception and Acceptance of Biosimilars in Oncology” (Journal of Clinical Pathways. 2017;3(8):31-35). Recognizing barriers provides an opportunity for healthy debates on how best to develop strategies to overcome them. We agree that payers will always play a major role in patient access for any new entrant to market, but harmonized collaboration between payers and other stakeholders will hopefully mature to help patients in need of CAR-T therapies. Proof of the impediments to rapid deployment of CAR-T technology is the less-than-robust market uptake since FDA approval as well as the increasingly long queues of patients pending evaluation and treatment, as reported by Bloomberg news (12/5/17).
Apropos to the expression “necessity is the mother of invention,” the potential life-saving nature of CAR-T therapies and the observed responses in highly refractory patients may serve to expedite practical solutions to improve access for eligible patients. Such was the case for bone marrow transplant in hematologic malignancies two decades ago, as regional referral centers, bundles services and payments, shared risk pricing scenarios, provider to provider communication and patient handoffs, and comprehensive clinical guidelines normalized what was initially a too complex, too costly and too risky treatment alternative. We are but months since the first CAR-T approval and suggest cautious optimism for solving the complexities around this novel therapeutic drug class/procedure.