A new initiative from the VCCC Alliance Research and Education Lead (R&E Lead) Haematology program, led by Professor Con Tam is seeking to improve access to CAR T-cell therapy for patients undergoing treatment for blood cancer.
The relatively new therapy is an exciting prospect for clinicians and patients thanks to advances in genomic medicine, however it is a long and uncertain process, and not every patient will elect to pursue it. For this reason, the VCCC Alliance R&E Lead program has been liaising with haematologists across the state to explore practical ways of removing some of the barriers to treatment.
CAR T cells and how they work
CAR T-cell therapy involves the collection of a patient’s own T cells from their blood. CAR T cells are made by genetic modification in a laboratory so that they attach to antigens on cancer cells. Once a CAR T cell attaches to the cancer cell, the patient’s immune system sends other types of immune cells to kill the cancer cell and remove it from the body.
Prior to infusion of the cells, a patient will receive low doses of chemotherapy, not to kill cancer cells but so the CAR T cells can work as well as possible. The CAR T cells are then delivered into a patient’s bloodstream.
For patients with advanced diffuse large B-cell non-Hodgkin lymphoma, CAR T-cell therapy represents one of the greatest successes in translating basic tumour immunology into a new life-saving treatment. And yet the uptake of this therapy has been low in Victoria.
Time and distance are problematic for patients
To reverse this trend, the VCCC Alliance R&E Lead program has been assessing the barriers. One of the key factors relates to the distance that patients live from treatment centres.
The complexity of CAR T administration requires that patients travel to centres specifically accredited to deliver cellular therapies. Depending on where the patient lives, the impacts of the distance can be substantial. And there can be issues with follow-up if they live far from the treating centre.
Patients receiving approved CAR T-cell therapies are closely monitored for treatment-associated adverse events for around 2-3 months. Current practice demands that during at least the first month after discharge from the hospital, they need to remain close (within 30-minutes) to their treating hospital for regular follow-up or urgent care if required. They also require a full-time carer during these early months.
These requirements, along with the limited number of treatment sites, impose a burden that limits many patients’ access to the therapy with people on the outer reaches of Melbourne exposed to disparities in care. The cost of temporary relocation and upheaval to daily life are insurmountable for many.
Better understanding leads to more options
As doctors become more experienced and familiar with CAR T-cell therapy, they are learning how to recognise and respond to treatment-associated adverse events more efficiently. The VCCC Alliance collaborative group has reached an agreement that the current 30-minute distance from the treating hospital can be safely extended to 60-minutes. This relatively small but important modification will ultimately allow more patients to stay at home or with extended family during their treatment period thereby providing greater flexibility for patients and carers.
Recently, Peter MacCallum Cancer Centre has moved from 30 minutes to one hour, a shift which provides a greater opportunity for more patients in the Greater Melbourne area to remain at home rather than move into the city. For rural patients, there is continued access to supported accommodation.
‘This is definitely a positive change when we are considering referrals from the north.’ -
Dr Teresa Leung, Consultant Haematologist, Northern Health
It is hoped that the move will result in more patients having access to CAR T-cell therapy prompting an increase in survival rates and improving evidence of viable treatment strategies.
For more information contact Dr Jasper De Boer, Program Manager, VCCC Alliance Distributed Leadership.