A unique hub‐and‐spoke model to optimize patient management in lymphoma using novel chimeric antigen receptor‐T cell therapy in Southeast and South Asia

Abstract

Novel therapeutic options for cancer offer hope for patients and their families, particularly when the cancer has not responded to established treatment regimens. The chimeric antigen receptor (CAR)‐T cell therapeutic approach has changed the treatment paradigm for relapsed or refractory lymphoma, extending the capacity of the patient's own T cells to detect and eliminate cancer cells through genetic modification of T‐cell surface receptors. The process of establishing treatment centers and developing clinical expertize in this novel treatment strategy is complex. Time, resources, and a commitment to focusing health budgets on a new area are required. Currently, Singapore is the only country in southeast and south Asia with market authorization of the CAR‐T product, tisagenlecleucel. Availability of CAR‐T treatment across international borders provides patients in neighboring countries with choice in therapeutic options. This paper describes the unique hub‐and‐spoke cross‐border collaboration developed between Singapore and its neighbors to provide access to CAR‐T cell therapy for patients with relapsed or refractory lymphoma. To date in 2022, four patients have been included in the CAR‐T treatment cross‐border collaboration. Their stay in Singapore has been about 2 months' duration, including the pre‐treatment evaluation, apheresis, CAR‐T cell infusion and post‐treatment monitoring. Patient support from referring and treating physicians, critical to the success of the undertaking, is characterized by early communication, patient selection, multi‐disciplinary care, post‐treatment monitoring, and attention to detail. The patient journey and the development and implementation of this unique collaboration are discussed.

Experiences and perspectives on chimeric antigen receptor (CAR) T-cell therapy among recipients, carers and referrers (RE-TELL): a qualitative study to inform CAR T-cell service design

“…1 2 As a personalised cell and gene therapy involving gene modification of a patient's own T-cells, access to treatment is limited by logistical challenges and cost, while varied concerns regarding the technology need to be addressed, including equity of access, optimising the patient and support person experience, and cell and data sovereignty. [3][4][5] Internationally, CAR T-cell therapy provision has not consistently ensured equity of access, 6 7 and equity has been highlighted as a key area of focus for ongoing development of this treatment modality. 8 Aotearoa New Zealand (NZ) does not yet have a national service for standardof-care CAR T-cell delivery, with access limited to clinical trial use 9 or overseas treatment.…”