From a physician’s perspective, while CAR-T therapies hold unprecedented clinical promise for multiple refractory patients, the high-touch treatment model and need for consistent monitoring for side effects places considerable strain on hospital resources and limits CAR-T to centres of excellence (CoE). Along with the restrictive pricing, this CoE model further reduces patient access to CAR-Ts. One potential resolution is moving to outpatient settings, as improved toxicity management protocols and predictable side-effect onset timelines for newer CAR-Ts could enable CAR-T to be administered as an outpatient infusion, followed by readmission as and when necessary for side effect management. However, as CAR-T therapies aim to move into broader patient segments and earlier lines of treatment, the pressure on hospital resources will only intensify, even in outpatient settings. The question as to the risk: benefit ratio and the value proposition for CAR-T therapies has therefore never been more relevant. In the first of our three-part series on CAR-T therapies, Dr Alvaro Urbano shares his opinions on the current challenges in administering CAR-Ts, where he sees the greatest value for CAR-Ts in comparison to other more traditional modalities, and how concepts such as outpatient therapy or off-the-shelf CAR-T manufacture would impact clinical practice in Europe.
