Identifying Limitations to CAR T-Cell Therapies in Large B-Cell Lymphoma

Financial toxicity and limited access to centers specializing in CAR T-cell therapies may pose the biggest limitations for use of these therapies in patients with high-risk large B-cell lymphoma (LBCL), according to Jose Sandoval Sus, MD.

Sus, an associate member of the Malignant Hematology and Cellular Therapy Program at Moffitt Cancer Center, discussed limitations associated with the use of emergent CAR T-cell therapies in patients with B-cell lymphomas, contextualized by a presentation he gave at the 2025 National Immune Cell Effector Therapy (ICE-T) conference in Orlando, Florida.

He began by expressing that although CAR T-cell therapies are “incredibly active” in patients with B-cell lymphomas, historically, relatively few centers were specialized in their use. Although more institutions are becoming more specialized in their use, Sus suggests that more must be done to improve access to these agents.

Furthermore, Sus highlighted financial toxicities associated with CAR T-cell therapies, emphasizing their great expense. Considering continuing developments in CAR T-cell research, including 2 frontline trials in large B-cell lymphomas, he expressed that improving access and decreasing costs may help increase their utilization as these agents become available across a wider array of settings.

Transcript

In patients [with large B-cell lymphoma], there are a couple of limitations that we need to be aware of. Although these agents are incredibly active, we know that it’s limited to centers that specialize in cellular therapy. It used to be that there were fewer than 100 centers across the US, but more institutions are [becoming] specialized in this area of cellular therapy. We still have a long way to go, and a long way to providing more access to these lifesaving therapies to our patients.

Another important limitation is what we call financial toxicity. They're [quite] expensive agents, and we need to find a way, not only to improve access, but to make these medications less costly in the long run. I believe that there’s a potential for these types of therapies to [before second line in earlier lines and] maybe on the front line. We have at least 2 trials that I know of that are evaluating these agents in the front line for high-risk patients with large B-cell lymphoma. If you can imagine that it is going to expand the potential candidates for these treatments if these [outcomes] are positive.

We need not only to improve access, but also decrease the financial toxicity, [associated with] these medications. That’s an ongoing challenge that [many] of us in the fields are trying to find solutions [for], [including] working with our colleagues in pharmaceuticals.

Reference

Sandoval Sus J. Revolutionizing lymphoma treatment: the latest breakthrough in CAR-T therapy. Presented at the 2025 National Immune Cell Effector Therapy (ICE-T) conference. July 26, 2025.