Once considered an experimental treatment, chimeric antigen receptor (CAR) T-cell therapies have now become a well-established therapeutic modality for many patients in the United States since the first CAR-T product was approved in 2017. The research around CAR-T therapy continues to be encouraging, and CAR-T is transforming the long-term outlook for many patients fighting hematologic malignancies.
Today, there are five CAR-T products approved in the U.S. across multiple indications including various lymphomas and multiple myeloma (three in Large B cell lymphoma and one each in mantle cell lymphoma, follicular lymphoma, ALL, and multiple myeloma). These therapies have proven effective for many patients who may not have other treatment options available and offer the potential for long-term remission for some patients.
In addition to producing life-saving and life-prolonging outcomes, a 2019 study found that CAR-T reduces healthcare costs by at least one-third six months after treatment.  The results of this real-world study indicate that older patients with multiple comorbidities can be treated successfully with CAR-T therapy while reducing costs through lower hospitalization rates, bed days, and emergency department visits.
As CAR-T therapy becomes more widely adopted, perceptions among oncologists continue to evolve. Cardinal Health recently conducted a survey of more than 300 U.S. oncologists to better understand current beliefs and experiences with CAR-T. The 2021 survey augments similar research conducted in 2017, at a time when oncologists had limited practical experience referring or treating patients with CAR-T.
This year’s research was fielded using web-based surveys in February, March, and April. The participating oncologists work at a mix of community- and hospital-based practices where lymphomas and myeloma are frequently diagnosed and treated.
The survey found positive trends as well as barriers to broader adoption, as outlined in the latest edition of Oncology Insights, a biannual research-based report series authored by Cardinal Health. Here are five key findings:
Oncologists are more aware of CAR-T therapy compared to 2017. More than one in four oncologists said they are well informed and familiar with the most recent trial data. That compares with just 12% of oncologists in a similar study in 2017, during the early stages of CAR-T adoption.
Oncologists are more likely to have referred patients for CAR-T therapy. In the 2021 survey, 91% of oncologists said they have referred at least one patient for CAR-T therapy. That is an impressive increase from two surveys in 2019 that found 71% and 54% have referred at least one patient.  However, our 2021 survey found that only 18% of oncologists have referred more than three patients, which suggests additional education and support is needed.
Perceptions of the costs associated with CAR-T have improved. A solid majority – 60% – said either “costs are reasonable given this is a breakthrough therapy” or “costs are high but not inappropriate based on the efficacy data.” Forty percent said they see costs as a barrier, down from 44% in the 2017 survey.
Logistics of care remain a barrier, though views have improved. More than one-third (36%) of oncologists said the logistics of administering and following patients are cumbersome. That represents an improvement from 59% on the 2017 survey. Key concerns are centered around slow approval from payers and slow in-take from CAR-T centers.
Concerns about high toxicity are slightly more positive. High toxicity is a concern among 30% of oncologists, down from 35% in the 2017 survey. Despite promising outcomes, studies have found concerns about neurotoxicity. 
The increased interest in CAR-T therapies reflects an encouraging trend and bodes well for the broader use of advanced therapies. Our recent survey shows that oncologists are less concerned by costs and toxicity compared to four years ago, but there are important areas for improvement around the logistics of delivering care to patients. With better coordination among referring physicians, sites of care, payers, and biopharma, we are likely to see CAR-T usage continue to grow soon.
 “Medicare patients receiving chimeric antigen receptor T-cell therapy for non-Hodgkin lymphoma: A first real-world look at patient characteristics, healthcare utilization, and costs,” Kilgore KM, Mohammadi I, Schroeder A, et al, 2019 ASH Annual Meeting
 “Perceptions of community hematologists/oncologists on barriers to chimeric antigen receptor T-cell therapy for the treatment of diffuse large B-cell lymphoma,” Ajeet Gajra, Yolaine Jeune-Smith, Jonathan Kish, Ting-Chun Yeh, Skyler Hime, Bruce Feinberg, 2020
 “Adoption of Approved CAR-Therapies Among US Community Hematologists/ Oncologists,” Gajra A, Hime S, Jeune-Smith Y, Feinberg BA, Blood, 2020
 “Neurological adverse events following CAR T-cell therapy: a real-world analysis,” Ajeet Gajra, Marjorie E Zettler, Eli G Phillips Jr, Andrew J Klink, Jonathan K Kish, Stephanie Fortier, Sonam Mehta, Bruce A Feinberg, 2020
Featured Image used with permission from Cardinal Health.