Although some chimeric antigen receptor (CAR) T‑cell therapies have been available since 2017, only a fraction of eligible patients with treatable hematologic malignancies in the US and European Union receive them. Long‑term follow‑up from early studies is now confirming the curative potential of these cellular therapies, intensifying efforts to close the treatment gap.
The CAR T Vision report, published in June 2025 by a consortium of patient advocates, medical societies, academic and community treatment centers and other experts, issued recommendations across three priority areas and set a goal of doubling the number of patients receiving CAR T therapy by 2030.
“One in 5 patients who is eligible, both in the US and the EU, actually gets to CAR T therapy,” said Miguel‑Angel Perales, MD, cochair of the CAR T Vision steering committee and chief of the Adult Bone Marrow Transplant Service at Memorial Sloan Kettering Cancer Center. “It’s unethical to have a potential curative therapy that we cannot bring to patients.”
Perales and other CAR T Vision participants identified multiple barriers that limit access. Awareness gaps persist among patients and community physicians, many of whom are not specialists in cell therapy or large‑cell lymphoma and may be uncertain about eligibility criteria. Geographic barriers are significant: patients who live several hours from CAR T centers are less likely to be treated, and some US states lack any CAR T center. Additional obstacles include insurance and reimbursement issues, referral delays that can make patients too ill for treatment, and limited center capacity.
CAR T Vision convened stakeholders globally to define problems and begin targeted action. The initiative has formed working groups focused on awareness and education, resources and capacity, and financial sustainability for development and delivery. The groups aim to identify immediate actions for 2026 and longer‑term goals for 2027–2028 that together could increase patient access toward the 2030 target.
Regulatory changes are already easing some barriers. The US Risk Evaluation and Mitigation Strategy (REMS) for CAR T was revised to shorten required proximity and monitoring from 28 to 14 days and to focus on clinical safety. Perales noted that most severe toxicities, including cytokine release syndrome and neurotoxicity, resolve within two weeks, and that the shorter monitoring window reduces relocation and caregiver burdens that previously prevented some patients from receiving therapy.
Streamlining administration and monitoring could further expand access. Outpatient delivery reduces hospital bed use and may improve patient mobility and recovery; preserving microbiome diversity in outpatient settings has been associated with better outcomes in transplant and CAR T patients. Wider use of remote monitoring tools, including wearables that track temperature and vital signs, can support safe outpatient care but requires investment in infrastructure and overnight support systems.
Perales emphasized that progress will require coordinated action with regulators, payers and policymakers, as well as continued cooperation among clinicians, patient advocates and accreditation bodies. “We have to pivot into action mode,” he said, noting that measurable, collaborative steps are needed to ensure that more patients can benefit from potentially curative CAR T therapies.
Leave a Reply