When it comes to medical breakthroughs, innovations like CAR-T therapy are a boon to patients and their friends and families. However, such promising therapies are not universally available to every patient who wants or needs these solutions today. It’s no easy feat to ramp up production to mass scale and put in sufficient numbers of laboratories, research facilities and the medical professionals to take care of all of the logistics that go into immune-based therapies.
As noted in a report from Advisory Board, a CAR-T cell shortage is prompting medical providers to scramble to decide who will get treatment and who will not be able to receive it for the foreseeable future.
Background on CAR-T
CAR-T refers to “chimeric antigen receptor T-cell” therapy. A technician takes blood from a patient and modifies the T-cells so that they can recognize rogue cancer cells.
Then, the patient receives an infusion of these modified cells, where they go to work patrolling the bloodstream to seek out and destroy the cancerous cells.
Harnessing a patient’s own immune system can be a very powerful approach to therapy. But because of recent shortages, doctors have to consider the ethics of which patients will receive CAR-T treatment and which ones will not be able to enjoy its benefits, at least for the time being.
How Does One Decide Who Gets CAR-T Treatment?
It’s clear that society as a whole needs to give careful consideration to CAR-T therapy ethics. Per the report from Advisory Board, only about 70 cancer treatment centers in the U.S. are able to prescribe CAR-T therapy to patients. There are more patients who are eligible at any one time, but there are insufficient manufacturing resources to actually create the necessary components for the treatment.
Supply chain problems that have been affecting everything from toilet paper to infant formula to medications have been plaguing the nation for quite some time now. The coronavirus pandemic did nothing to remedy the situation, and has made things worse.
With limited supplies, “people are dying—about 20% of all our patients together are actually dying before they can get CAR-T,” according to Krina Patel, who serves as MD Anderson Cancer Center’s director of the myeloma cell therapy program.
But there are no national guidelines in place now to help clinicians determine which patients should go on the waiting list for therapy.
What Is the Current State of Access to CAR-T Therapy?
There is no single registry to look up the overall access levels to patients for CAR-T therapy. But some insight can be had from the Mayo Clinic, where Yi Lin, who serves as medical director of their cellular therapy program, said of the number of patients who can get treatment: “The median is 1 to 2 slots per month. She explained that “it ranges from 0 to 4 per center, and some cancer centers get no slots.” Lin said that clinicians “have to pick off a list of close to 100 patients to get these slots.”
Supply Chain Logistics Affect the Medical Community Around the World
The planet has been hampered by supply chain problems since the global coronavirus pandemic exacerbated the thin margins our warehouses were operating under. Disruptions in the production cycle from labor force shortages in manufacturing, quality control and delivery all contribute to problems obtaining vitally needed medical supplies.
Reduced access to CAR-T therapy is part and parcel of this problem. It’s a reminder to everyone that we can’t take our supply chains for granted and that medical professionals need to keep the public informed about potential shortages so they can be motivated to do something about such problems.