Year: 2023
Type: article
Abstract: In this issue of Blood, Chihara et al 1 report low real-world utilization, but encouraging efficacy, of chimeric antigen receptor (CAR) T-cell therapy as third-or later-line therapy for older adults with diffuse large B-cell lymphoma (DLBCL).The authors interrogated the Medicare Fee-for-Service claims database to evaluate outcomes and health care utilization costs associated with CAR T-cell therapy (CAR-T) with a specific focus on older adult (aged ≥65 years) patients with DLBCL treated over a 2-year period (2018-2020).DLBCL predominantly affects older adults, with the majority of patients aged over 60 years and one-third ≥75 years at diagnosis 2 (see figure).Historically, outcomes were poor for patients of any age with disease refractory to, or progressive after, frontline therapy.CD19-directed autologous CAR-T has revolutionized care for those patients.Despite improved outcomes with CAR-T, most recently illustrated by randomized trials in the second-line setting, 3,4 multifactorial barriers limit uptake in the older adult.It has been repeatedly demonstrated that older patients are more likely to be underrather than overtreated, and nonreferral is the greatest barrier to specialized treatment for hematologic malignancies.5 Chronological age continues to influence oncologists' decision making, 6 with concerns including uncertainty regarding eligibility, the presence of comorbidities, impaired physical or cognitive function, caregiver support, distance to a specialized treatment center, and potential societal and patient-level costs.5 Although these concerns are valid, they can also result in withholding or attenuation of curative regimens.Given the context, multiple illuminating features of this report warrant attention.
Source: Blood
Authors: Ciara L. Freeman, Frederick L. Locke
Institution: Moffitt Cancer Center
Language: English
Topic: CAR-T cell therapy research
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4386910430