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managing expectations

car t-cell therapy is the next big cancer treatment hitting the canadian cancer treatment landscape— with one recently approved car t-cell therapy and another on the way for use in specific patients with B-cell acute lymphoblastic leukemia [ALL] and large B-cell lymphoma, respectively.

attention in the press has led to tremendous excitement and high demand about these therapies but managing expectations will be a real challenge. car-t presents exceptional potential. clinical trials have shown huge remission rates of up to 94% in severe cancer types. this is particularly impressive considering most car-t clinical trials recruit cancer patients that have not responded to other available treatments. these results have fed the expectations of patients.

but translating trial results into the clinic often yields unexpected patient responses and these results may not be the same in the real world. the challenge now will be managing patient expectations as car t-cell therapy comes to market in canada, including how patients are selected and when, throughout their treatment process, and even once they have returned home after receiving treatment.

this increasing awareness of car-t and the success rates for some patients has inundated cancer patients with promises of new “miracle drugs”. it is our responsibility to start navigating conversations with patients who have heard about the potential of this therapy, but who don’t fully understand what does and does not apply to them.

presently car t-cells will be limited to certain certified centres across canada, and only provided to patients who meet strict eligibility criteria unlike other chemotherapeutic agents with broad access. because car-t is not offered in all provinces, some patients and their caregivers will be required to travel to receive treatment. some will have to travel to academic centres within their province [currently only in québec and ontario]. this will have a significant impact on families and caregivers- not only time away from work and family, but also the substantial out of pocket costs that will be required. additionally, patients who do not have support from a caregiver will likely not be offered the treatment.

car-t is only available to patients who have failed all other lines of therapies. it will be crucial for patients to recognize where car t-cell therapy fits into their treatment paradigm. patients wanting access as an earlier option will need to be mitigated. interestingly, the blood wise group out of the UK reported patients looking for adverse events as an indication that the infusion was actually working. while there has been impressive data in blood cancers, investigators are still looking to see if there is a future for car-t in solid tumours.

car t-cell therapy will be an important addition to the cancer treatment landscape. once it has been added to provincial formularies it will be crucial to manage expectations and ensure the promise of car-t is actualized. but what can we actually expect from this technology and ultimately how patient expectations will be managed will be the true test of its actual potential.


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