Michael Bishop, MD, professor of medicine and director of the cellular therapy program at UChicago Medicine, has spent his entire career trying to provide options for patients who don’t have options. That’s why it’s so rewarding to bring CAR T-cell therapy to his patients.
“Nobody likes to watch a patient die, so trying to provide that opportunity for a cure…trying to set this up,” Bishop says. This was easy. It was a work of love. I’ve never used that term at work before.”
Bishop pushed to get UChicago Medicine involved in clinical trials for Kymriah (tisagenlecleucel) for treating children and young adults with an untreatable form of acute lymphoblastic leukemia and Yescarta (axicabtagene ciloleucel) for use in adults with certain types of non-Hodgkin lymphoma.
Kymriah received FDA approval in August 2017 for the treatment of patients up to 25 years of age with B-cell precursor acute lymphoblastic leukemia that’s refractory or in second or later relapse. In October 2017, FDA approved Yescarta for adult patients with relapsed or refractory large B-cell lymphoma after two or more lines of systemic therapy.
According to the FDA, diffuse large B-cell lymphoma is the most common type of non-Hodgkin lymphoma in adults. There are approximately 72,000 new cases of non-Hodgkin lymphoma diagnosed in the United States each year; diffuse large B-cell lymphoma comprises approximately one in three newly diagnosed cases.
Acute lymphoblastic leukemia accounts for less than half of 1% of all cancers in the United States, according to the American Cancer Society; an average person’s lifetime risk of getting acute lymphoblastic leukemia is approximately 1 in 1,000, and the risk is slightly higher for males than in females.
What follows is advice from Bishop and other experts for healthcare executives who want to deliver these therapies.
1. Make a strong case to the C-suite
First, think about what’s important to your executive team, says Luca Capicchioni, program manager for stem cell transplant and cellular therapy at UChicago Medicine. “They’re probably fielding hundreds of requests—very frequently for more resources—so you have to think about this from their perspective.”
Academic medical centers should make a strong case about the research and teaching possibilities with providing CAR T-cell treatment, he advises. That’s in addition to the impact on patient care.
Parameswaran Hari, MD, hematologist/oncologist and chief of the hematology and oncology division at Froedtert Hospital and Medical College of Wisconsin Clinical Cancer Center, agrees. “If the hospital isn’t investing in CAR T-cell therapy, that’s short-sighted. [The hospital] is going to be left behind,” he says. And that could mean losing patients to other provider organizations.