CAR T Therapy Access Remains Uneven Despite Specialist Referral
Key Clinical Summary
- 44% of patients referred for chimeric antigen receptor T-cell (CAR T) therapy did not ultimately receive treatment at a large US academic cancer center.
- Black race and multiple myeloma were associated with lower odds of CAR T receipt, with Black race remaining significant in multivariable analysis.
- Rapid disease progression, lack of available CAR-T options, and toxicity concerns were the most common reasons for nonreceipt.
CAR T therapy has reshaped treatment paradigms for hematologic malignant neoplasms, yet real-world access remains inconsistent. A retrospective cohort study from Memorial Sloan Kettering Cancer Center (MSKCC) examined how often referred patients receive CAR T therapy, why some do not, and whether disparities exist. The findings highlight persistent clinical, logistical, and equity-related barriers.
Study Findings
Investigators analyzed 400 adult patients referred to the Cellular Therapy Service at MSKCC between September 2021 and July 2023, with follow-up through May 2024. Nearly half of referrals were for non-Hodgkin lymphoma (49%), followed by multiple myeloma (44%) and other hematologic malignancies (7%). The median patient age was 66 years, and 62% were male.
Overall, 177 patients (44%) did not receive CAR T therapy. In univariate analyses, multiple myeloma diagnosis, Black race, worse performance status, and external referral were associated with lower odds of receiving CAR T. In multivariable logistic regression, Black race remained independently associated with reduced likelihood of CAR-T receipt (OR, 0.30; 95% CI, 0.09-0.89), although race as a whole was not statistically significant.
Among patients who did not proceed to CAR T therapy, the most frequent primary reasons were rapid disease progression (21%) and lack of an appropriate approved or investigational CAR T option (21%). Concerns related to potential toxic effects accounted for 19% of cases. Reasons for nonreceipt varied by disease type, with myeloma patients facing different barriers than those with lymphoma.
Clinical Implications
For oncology leaders and pathway developers, these findings underscore that referral alone does not guarantee access to CAR T therapy. Nearly 1 in 2 referred patients failed to receive treatment, suggesting inefficiencies across the care continuum. Delays related to disease progression point to the need for earlier referral strategies and potentially faster manufacturing timelines.
The identification of a potential racial disparity, even in a high-resource academic setting, raises concerns for payers and policymakers focused on equitable access to advanced therapies. Although the number of Black patients was small, the association persisted after adjustment, signaling the need for further investigation and targeted interventions.
Additionally, the absence of suitable CAR T options for more than one-fifth of non-receiving patients highlights ongoing gaps in product availability, particularly for multiple myeloma. Toxicity concerns and logistical challenges, such as relocation requirements, also remain significant and may influence pathway design and coverage decisions.
The authors emphasized that prior research has focused mainly on lymphoma or community settings, limiting broader conclusions. They also cautioned that the retrospective design and single-center scope of the study constrain generalizability.
Conclusion
Despite its transformative potential, CAR T therapy remains inaccessible for a substantial proportion of referred patients. Addressing referral timing, product availability, toxicity mitigation, and logistical barriers will be essential to improve access, optimize oncology clinical pathways, and ensure equitable delivery of this life-extending therapy.
Reference
Valtis YK, Chin K, Nemirovsky D, et al. Barriers to chimeric antigen receptor T-cell therapy. JAMA Oncol. 2025;11(7):781–784. doi:10.1001/jamaoncol.2025.1127
