Dr Venkataraman on Potential Disparities in Access to Cellular Therapies in Sarcoma

"As we develop these technologies and these really exciting tools, we have to make sure that they're equitably accessible and available to all patients. We need to be proactive in that."

Vinayak Venkataraman, MD, director of Sarcoma Pathways and affiliated faculty at McGraw/Patterson Center for Population Sciences at Dana-Farber Cancer Institute, as well as an instructor in medicine at Harvard Medical School, discussed anticipated challenges with the development and incorporation of emerging cellular therapies into sarcoma care.

Although the development of T-cell receptor (TCR) technologies represents a significant therapeutic advancement, Venkataraman highlighted that the inherent biological requirements for these treatments may inadvertently exacerbate existing racial and ethnic disparities in sarcoma care.

A primary concern involves the fundamental difference between standard CAR T-cell therapies and the emerging TCR-based products used in solid tumors such sarcoma. Unlike CAR T-cells, which target specific external surface antigens regardless of the patient's genetic background, TCR therapies require the target antigen to be presented through a specific human leukocyte antigen (HLA). Because the technology is HLA-restricted, patients must possess a specific genetic marker—most commonly HLA-A*02—to be eligible for these clinical interventions

Venkataraman spotlighted findings from an epidemiologic study evaluating the effect of these restrictions on access to afamitresgene autoleucel (Tecelra) in advanced synovial sarcoma. The analysis revealed a stark disparity in eligibility; overall, only approximately 20% to 30% of the patient population would actually be eligible for the product based on their HLA status, he reported. Crucially, the likelihood of eligibility is significantly higher for patients of European descent and markedly lower for those who identify as African American, African, or Asian Pacific Islander.

The study underscores the necessity for the oncology community to be proactive as these "exciting tools" are refined and brought to market. Venkataraman concluded that as researchers develop these powerful technologies, they must remain committed to ensuring they are equitably accessible and available to all patients, regardless of their ethnic or racial background.