More than 200 oncologists weigh in on CAR T-Cell therapy, biosimilars and AML therapies

Chimeric antigen receptor (CAR) T-Cell therapy has emerged as one of the most promising developments in immuno-oncology, with a number of clinical trials demonstrating full remission in otherwise highly refractory patients, who have few to no treatment options. The FDA, in a landmark move, this year approved the first two CAR T-Cell therapies—one indicated for a form of acute lymphoblastic leukemia in pediatric and young adult patients, and the other for adult patients with refractory or relapsed diffuse large B cell or high-grade lymphomas.

Today, the majority (51 percent) of oncologists see CAR T-cell therapy as a potentially game-changing approach to cancer treatment. Despite this growing optimism, barriers still exist to its adoption. For instance, 41 percent of oncologists might hesitate to refer patients due to concerns over toxicity, while others feel that the high costs of the therapy, as well as the complicated logistics of its administration, may cause them to limit their number of referrals.

"The concerns shared by community oncologists may reflect a lack of familiarity with published clinical data on CAR-T, or they may reveal a lack of first-hand experience, as the therapies are so new to the market," said Dr. Chadi Nabhan, vice president and chief medical officer of Cardinal Health Specialty Solutions. "However, given the complexities of CAR-T synthesis and delivery, the need for continued and ongoing physician education is clear."

In spite of the newness of biosimilars — medicines that contain an active substance highly similar to an already approved biologic product — they enjoy a broad and growing awareness among oncologists.

Over the past two years, nine biosimilars were approved for use in the U.S. (three for use with cancer patients), and it's expected that numerous more products will hit the market over the next few years.

This is expected to drive price competition among specialty therapeutics, which could factor into the adoption of biosimilars, as 66 percent of oncologists say that it's either extremely or very important to save costs when prescribing them.

Today, just 17 percent of oncologists lack familiarity with biosimilars (a significant leap from 22 percent last year), and already, a majority are open to prescribing such treatments in place of their reference products. However, some oncologists report concerns over label expansion through extrapolation, in areas where they feel there may not be sufficient clinical trial evidence to warrant prescribing.

"In spite of this and their lack of experience with biosimilars, a strong majority state a willingness to prescribe biosimilars across all reference brand label indications and therapeutic areas, regardless of whether the biosimilar is supportive care or therapeutic, or whether it is a palliative treatment or used with curative intent," said Dr. Bruce Feinberg, vice president and chief medical officer of Cardinal Health Specialty Solutions. "Such responses suggest the barriers to biosimilar adoption are much lower now than they were a year or two ago."