City of Hope, one of the largest cancer research and treatment organizations in the United States, continues to be at the forefront of advancing chimeric antigen receptor (CAR) T cell therapy. The leading-edge treatment technology is utilized by City of Hope physician-scientists in active preclinical and clinical programs across a range of blood cancers — including leukemia, lymphoma and myeloma — and solid tumor types.
In CAR T cell therapy, immune cells are taken from a patient’s bloodstream, reprogrammed to recognize and attack a specific protein found in cancer cells, then reintroduced into the patient’s system, where they get to work destroying targeted tumor cells.
To address the potential for complications associated with CAR T therapy — including cytokine release syndrome (CRS) and immune effector cell associated neurotoxicity syndrome (ICANS) — the treatment has typically been administered in an inpatient setting.
However, as scientific advancements and clinical use cases for CAR T cell therapies grow, so too does interest in outpatient CAR T models as a safe and effective way of expanding patient access to this lifesaving treatment. Outpatient settings can provide the full benefits of CAR T therapy for cancer while enabling patients to return home in between treatments.
In a recently published review, a multidisciplinary team of City of Hope physician-scientists have detailed the considerations necessary for successful development and implement of outpatient CAR T therapy. The paper, published in Seminars in Hematology, was led by Jennifer S. Woo, M.D., a pathologist and the medical director of blood bank and transfusion medicine services for City of Hope Orange County; Kim Nguyen, a clinical pharmacist specialist at City of Hope Orange County Lennar Foundation Cancer Center; Lawrence Liu, M.D., a hematology and medical oncology fellow at City of Hope Comprehensive Cancer Center; Amrita Krishnan, M.D., the executive medical director of hematology for City of Hope Orange County; Tanya Siddiqi, M.D., the medical director of lymphoma for City of Hope Orange County; and Azra Borogovac, M.D., M.S., a hematologist at City of Hope Orange County Lennar Foundation Cancer Center.
"With the expanding indications of CAR T cell therapy across various malignancies, outpatient CAR T cell therapy is poised to become the future standard, making this lifesaving treatment more accessible to a broader patient population,” says Dr. Borogovac.
Key Findings
Through a comprehensive review of current available data on CAR T cell outpatient programs, the City of Hope team determined that these settings can provide meaningful benefit by lowering overall costs, enhancing patient comfort, and improving access to care. However, securing those advantages requires a robust infrastructure. The key components include:
- Expert cellular therapy committee. Cancer institutions should establish an expert committee to review patient eligibility for outpatient CAR T and determine the appropriate product for each patient.
- Thorough product selection. With multiple FDA-approved CAR T cell treatments available, medical centers exploring an outpatient model should only select products that align with their operational capabilities and comfort level. “The transfusion medicine service at City of Hope Orange County takes immense pride in facilitating the chain of custody and preparation of lifesaving cellular therapy products,” says Dr. Woo.
- Adequate operational space. An outpatient CAR T cell therapy program requires access to expert cancer care with 24/7 support. CAR T administration spaces should be exclusively designated for patients receiving cellular therapy products to minimize exposure.
- Comprehensive clinical monitoring. Perhaps one of the most critical components, medical teams should create a detailed plan for outpatient treatment. Most CAR T outpatient plans require daily visits from patients and caregivers for the first 14 days after infusion. The paper includes an example timeline of how this monitoring might be structured.
- Management of CAR T toxicity. In the case of toxicity or negative reaction, each institution should have predetermined criteria for admission to ensure timely and apt care. Outpatient centers should be ready to begin preliminary work-up and treatment while the patient awaits transfer to a hospital.
Driving the field forward, City of Hope Orange County is helping to pioneer advanced care for blood cancer — combining innovative research discoveries with superior clinical treatments to improve outcomes for patients. City of Hope is at the forefront of CAR T cell therapy, and has one of the largest cell therapy programs in the United States, which is offered across the organization’s national network. City of Hope is also one of the few institutions in the nation to advance CAR T cell therapy through its own research and clinical trials.
“At City of Hope Orange County, we are honored to lead these advancements, offering our community the hope and healing they deserve through outpatient CAR T therapy," says Dr. Borogovac.
Pursuing cancer cures at the speed of life. CityofHope.org/OC | 888-333-HOPE (4673)
Also read:
Talking Hope: How precision medicine is personalizing cancer care
City of Hope Orange County leads lifesaving immunotherapy research and treatment for hematologic cancers
Talking Hope: “A new blessing every day”: Meet two-time cancer survivor Kathy Miller Willahan