COMMUNITY ONCOLOGISTS’ PERCEPTION AND ADAPTABILITY TO EMERGING CAR-T THERAPIES

• Published in: Value in health Vol. 20; no. 5; p. A137
• Main Authors: Nabhan, C, Feinberg, BA, Ernst, FR, Fillman, J
• Format: Journal Article
• Language: English
• Published: Lawrenceville Elsevier Science Ltd 01.05.2017
• Subjects: Adaptability; Barriers; Cancer; Cancer immunotherapy; Chimeric antigen receptors; Clinical research; Clinical trials; Community-based programs; Efficacy; Familiarity; Geography; Impressions; Lymphocytes T; Malignancy; Oncologists; Oncology; Patients; PD-1 protein; Penetration; Prescribing; Secondary schools; Solid tumors; Technology; Toxicity; Tumors
• ISSN: 1098-3015; 1524-4733
• DOI: 10.1016/j.jval.2017.05.005

OBJECTIVES: Chimeric Antigen Receptors of T cells (CAR-T) are emerging cellular-based therapies with remarkable responses in several hematologic malignancies and solid tumors. Regulatory approval of this technology is expected in less than 12 months. Little is known about barriers to market penetration, oncologists' acceptance, and forecasted use within current patterns of care. The purpose of this study was to understand clinician perspectives regarding these barriers. METHODS: This descriptive study identified CAR-T-related attitudes among 87 community-based US oncologists of various geography and practice types. Data were collected at two live meetings with audience response technology. RESULTS: Regarding personal experience: 20% referred at least one patient in the preceding 12 months for a clinical trial. Impressions of CAR-T were highly variable: 33% believed it a game changer, 23% another anti-cancer option, 21% similar to other immuno-oncology (i.e. anti PD-1 and PDL-1) and 33% lacked familiarity. Likelihood of prescribing CAR-T: 63% said limited to hematologic malignancies, 50% believed <10% patients eligible, while 20% didn't foresee any potential patient. The top 5 cited barriers to use: logistics (72%), cost (35%), toxicity (35%), clinical trial eligibility criteria (22%), and lack of efficacy (17%). Regarding site of care 43% plan to refer all eligible patients to academic institutions, 26% plan on referring some, and 30% anticipated treating their patients locally at their own centers. CONCLUSIONS: Many community oncologists believe that CAR-T therapy is a game changer. Many perceive logistics, toxicity, and cost as major barriers. The fact that nearly one third expect to personally administer CAR-T exposes a significant education gap regarding the complexity of therapy. Comprehensive education initiatives for community oncologists and scalability of this technology are needed to optimize referral channels which will be essential to wider market adaptability once CAR-Ts are approved for adult malignancy.