Socioeconomic and Racial Disparity in Chimeric Antigen Receptor T Cell Therapy Access

Ahmed, Nausheen; Shahzad, Moazzam; Shippey, Ernie; Bansal, Rajat; Mushtaq, Muhammad Umair; Mahmoudjafari, Zahra; Faisal, Muhammad Salman; Hoffmann, Marc; Abdallah, Al‐Ola; Divine, Clint; Hamadani, Medhi; McGuirk, Joseph P.; Shune, Leyla

doi:10.1016/j.jtct.2022.04.008

Cited by 51 publications

(29 citation statements)

References 27 publications

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“…About a quarter of patients who received CAR T-cell treatment on trials for myeloma lived over 2 hours away. 32 Most centers require local stay for up to 30 days after CAR T-cell infusions and this is an important barrier for some patients. Many programs utilize grants, donations, or other funding to help overcome this cost, while local lodging resources such as Hope Lodge (provided by American Cancer Society) have made CAR T-cell treatment available to patients who cannot afford local lodging.…”

Section: Access To Carementioning

confidence: 99%

“…A recent study utilizing the Vizient ® Clinical Database showed multiple disparities in access to CAR T-cell treatment on clinical trials. 32 Despite African Americans representing close to 20% of new myeloma cases, they made up only 1% of patients who received CAR T-cell treatment. Conversely, white individuals are over-represented in clinical trials and made up 65% of patients with MM treated with CAR T-cell therapy.…”

Section: Access To Carementioning

confidence: 99%

“…This important treatment remains elusive to the uninsured who represent 1% and Medicaid beneficiaries who represent 2.3% of patients treated with myeloma CAR T-cells in trials, in keeping with non-CAR T-cell treatments. 32…”

Section: Costmentioning

confidence: 99%

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CAR T-Cell Therapy for Patients with Multiple Myeloma: Current Evidence and Challenges

Rendo¹,

Joseph²,

Phan³

et al. 2022

BLCTT

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The therapeutic landscape of multiple myeloma (MM) has benefited from an emergence of novel therapies over the last decade. By inducing T-cell kill of target cancer cells, chimeric antigen receptor (CAR) T-cell therapies have improved outcomes of patients with hematologic malignancies. B-cell maturation antigen (BCMA) is the current target antigen of choice for most CAR T-cell products under investigation for MM. However, their shortcomings deal with logistical and clinical challenges, including limited availability, manufacturing times, and toxicities. This article provides an overview of recently developed and investigational CAR T-cell therapies for MM, highlighting current evidence and challenges.

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Section: Access To Carementioning

confidence: 99%

Section: Access To Carementioning

confidence: 99%

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CAR T-Cell Therapy for Patients with Multiple Myeloma: Current Evidence and Challenges

Rendo¹,

Joseph²,

Phan³

et al. 2022

BLCTT

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“…The poor representation of racial and ethnic minorities in early-phase and pivotal CAR T-cell trials has limited this analysis. 7 , 8 …”

Section: Introductionmentioning

confidence: 99%

The impact of race, ethnicity, and obesity on CAR T-cell therapy outcomes

et al. 2022

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Cancer outcomes with chemotherapy are inferior in patients of minority racial/ethnic groups and those with obesity. Chimeric antigen receptor (CAR) T-cell therapy has transformed outcomes for relapsed/refractory hematologic malignancies, but whether its benefits extend commensurately to racial/ethnic minorities and patients with obesity is poorly understood. With a primary focus on patients with B-cell acute lymphoblastic leukemia (B-ALL), we retrospectively evaluated the impact of demographics and obesity on CAR T-cell therapy outcomes in adult and pediatric patients with hematologic malignancies treated with CAR T-cell therapy across five phase I clinical trials at the National Cancer Institute (NCI) from 2012 to 2021. Among 139 B-ALL CAR T-cell infusions, 28.8% of patients were Hispanic, 3.6% were Black, and 29.5% were overweight/obese. No significant associations were found between race, ethnicity, or body-mass index (BMI) and complete remission rates, neurotoxicity, or overall survival. Hispanic patients were more likely to experience severe cytokine release syndrome compared to white non-Hispanic patients even after adjusting for leukemia disease burden and age (odds ratio 4.5, p = 0.001). A descriptive analysis of patients with multiple myeloma (n=24) and NHL (n=23) displayed a similar pattern to the B-ALL cohort. Our findings suggest CAR T-cell therapy may provide substantial benefit across a range of demographics characteristics, including for those populations who are at higher risk for chemotherapy resistance and relapse. However, toxicity profiles may vary. Therefore, efforts to improve access to CAR therapy for underrepresented populations and elucidate mechanisms of differential toxicity among demographic groups should be prioritized.

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“…The relevance of such studies will only increase as we see cancer treatments become more expensive and less accessible ( 5 ). The papers in this Research Topic bring important contributions to this debate.…”

mentioning

confidence: 99%

Editorial: Epidemiological trends in hematological malignancies

Lima

Castillo²,

Merli³

et al. 2023

Front. Oncol.

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Ou et al. performed a global population-based epidemiologic study of disease burden of chronic lymphocytic leukemia (CLL) in years 1990 to 2019 that included disability-adjusted life years (DALY) and age-standardized rates (ASR). They observed that CLL agestandardized incidence rate is growing worldwide, except in North America and Oceania. Also, unsurprisingly, the socio-demographic index (SDI) correlated with the burden of death and DALY. SDI is a measurement of country/regions development status that correlates with health outcomes. In low SDI quintiles, age-standardized death rate and age-standardized DALY rates went up, while decreasing significantly in high SDI quintiles. Presumably this disparity reflects access to newer and expensive medications, and to health care in general. Unfortunately, information from low SDI countries is limited and CLL incidence may be underestimated. Despite this intrinsic constraint, the paper illustrates what physicians everywhere know firsthand: social economic inequality is a major determinant of survival for patients with cancer, a sad determinant that is depicted here in the context of CLL.Tang et al. used the Surveillance, Epidemiology, and End Results (SEER) to describe epidemiologic, prognostic and treatment outcomes of patients with primary central nervous system lymphoma. The SEER Program is supported by the Unite States National Cancer Institute and provides information on USA cancer statistics (1). The authors showed that race, sex, age, marital status, surgical resection and chemotherapy were independently associated with survival. The paper reflects the power of large databases such as SEER, but also illustrates the limitations of such analyses. Detailed risk stratification and treatment aspects were not available, for example. But it is interesting to notice that single patients had worse survival than married patients, likely indicating the importance of support provided by a spouse caregiver. Patients identified as Black, despite representing only 7% of this cohort, also had shorter survival than White patients.Wu et al. also used SEER to review survival trends in patients under age 65 years with mantle cell lymphoma (years 1995-2016). They divided years of diagnosis in three eras: chemotherapy-alone (1995)(1996)(1997)(1998)(1999)(2000), intensified immunochemotherapy era (2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012) and targeted therapy era (2013-2016) and compared survival in these time frames. The patient population was predominantly white, but 5.8% were Black and 10.6% were Hispanic. In multi-variate analysis, male gender, age, and disease stage predicted survival, while race did Frontiers in Oncology frontiersin.org 01

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Socioeconomic and Racial Disparity in Chimeric Antigen Receptor T Cell Therapy Access

Cited by 51 publications

References 27 publications

CAR T-Cell Therapy for Patients with Multiple Myeloma: Current Evidence and Challenges

CAR T-Cell Therapy for Patients with Multiple Myeloma: Current Evidence and Challenges

The impact of race, ethnicity, and obesity on CAR T-cell therapy outcomes

Editorial: Epidemiological trends in hematological malignancies

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