iwCAR-T 2025 | Improving access and delivery of CAR T-cells and bispecific antibodies in the community

Krish Patel:
Hello everybody, I’m Krish Patel from the Sarah Cannon Research Institute, here at the iwCAR-T meeting with my colleagues, tell us about yourselves.

Tara Graff:
Hi, I’m Dr Tara Graff from Mission Cancer and Blood in Des Moines, Iowa. I’m a lymphoma specialist and I lead the clinical trials program at Mission Cancer and Blood.

Caron Jacobson:
And I’m Caron Jacobson, I’m a lymphoma doctor at the Dana Farber Cancer Institute in Boston, and also run our cell therapy program.

Krish Patel:
So we just had this really exciting session talking about how to improve delivery of immune effector cell therapies like CAR T-cells and bispecific antibodies in the community. So Dr Graff, can you summarize, what have you learned through your efforts in your organization and share with us kind of what do you think is the roadmap for?

Tara Graff:
That’s a great question. So, you know, every site is a little bit different. So three years ago, a little bit over now when I think about it, we were offered one of the first bispecific trials. And I was very excited to be able to do that, but we hadn’t really had a cellular therapy program in place. We hadn’t done transplant. We had never done CAR-T. And so it wasn’t a matter of not being able to do it. It was just putting the pieces together to be able to build, number one, a safe program, right? Because safety first when it comes to these therapies. And so I think the important thing is really figuring out, you know, your strengths and your weaknesses and what weaknesses can be overcome. You know, strengths are strengths. They’re not going anywhere, but there are some weaknesses and I shouldn’t even use the word weaknesses. There are some logistical barriers that can be overcome and fixed and rectified. And there are other things that there really isn’t a workaround and that would sort of be a no go. But for us, we really had all the pieces in place. And so it was really, you know, figuring out a strong team, figuring out the logistical barriers, you know, making sure there was a relationship with the hospital staff, you know, who was going to monitor these patients and manage, you know, calls in the middle of the night, should they come in? What were we going to do if they had, you know, issues or side effects such as cytokine release syndrome or neurotoxicity? And so that was something that was really, you know, important for me to figure out and have a plan before we started our first patient.

Krish Patel:
Yeah, I think a lot of different considerations there. And I think as was raised in the discussion, partnerships between sites that have had a lot of experience and those that are just getting started is a really important way to kind of improve access. Dr Jacobson, you were telling us a little bit about your experience in doing that and tell us what you think is critical to share.

Caron Jacobson:
Yeah, I mean, I just want to emphasize that, you know, Dr Graff’s experience with the first bispecific trial was not dissimilar from my experience in 2013 when we had our first CAR T-cell trial open at Dana-Farber. We had no idea what we were doing. We had to do all the same things. And I think as long as you have the tools in place to be able to address all of the needs, then I think you are a site that can do this. And it doesn’t have to be an academic center in a large city. It can absolutely be a community center.

But I think really, really crucially, you have to have a hospital partner that not only where the patients can go, but where the ICU physicians or the medicine subspecialty consultants or the emergency room is willing and able and interested in partnering with you to take care of these patients. You know, even in Boston where it’s very concentrated in terms of the number of centers that can administer these therapies, we still serve a very extended radius where we get people basically at the Canadian border in Maine. And that road, the time it takes for those patients to get to us is not something that they’re willing to do weekly or even biweekly for four or five weeks. And so it’s really important for us to find sites like Tara’s that are a little bit further afield where once I hear about those patients, I can refer them to those centers and patients can have more ease and more access. So this is only a good thing. I think finding sites like that, it’s not going to get, I always say, it’s not going to get CAR-T or bispecifics in everyone’s backyard, but it’s going to bring it closer to people and increase the number of people who do have it in their backyard.

Krish Patel:
Yeah, I think great points. There’s really this learning curve that there is for all of us, right? And so being able to find that layer of support that you really need to be able to safely deliver those therapies is critical. One of the questions that came up in the panel was really this idea that perhaps more uptake is going to be driven by this broader proliferation of these technologies and therapies and diseases outside of heme. Are you starting to see more of that? Do you see that as really maybe the extra push to get more sites to be able to safely deliver these therapies?

Caron Jacobson:
You know, personally, I think that with, you know, we’ve been hearing so much recently about, you know, CAR-T and bispecifics and autoimmune diseases. And the academic centers are doing such a heavy lift already with all the patients, their own patients. First of all, you have your own patients and then you’re being, you know, sometimes asked to just do the step-up dosing. But in a lot of cases, just being sent those lymphoma, myeloma, depending on, you know, the disease state, sent those patients and they don’t come back to the community site because they’re happy once they’ve been sent. So that’s going to increase the burden. I mean, you know, there aren’t endless resources at the academic level either. And so I think community sites need to help. Again, does that mean every community site across the country? No. I think, again, it’s important to identify those sites that have been doing bispecifics. And I don’t just mean one or two. I mean, have, you know, very good programs, flourishing programs that have proven, you know, their safety record, their efficacy record, and their efficiency record, I should say, even more importantly, too. But we need to be able to help because CAR-T isn’t going anywhere. Bispecifics are not going anywhere. They’re just going to get moved up. And so just within the oncology state, we need to be able to help. And now you factor in the autoimmune arm of all of this. We need to work together and I think really bridge that gap to co-manage these patients when we can.

Krish Patel:
Yeah, I mean, certainly so many different populations now we’re seeing more bispecifics in solid tumor as well. Really large populations of patients where I think that access piece becomes even more critical. I just want to say thank you to our panelists today and thanks to everybody for joining us at iwCAR-T.

This transcript is AI-generated. While we strive for accuracy, please verify this copy with the video.