Quality of Life and Neurotoxicity Management in Later-Line Cancer Treatment

Dr. Kalantri turned the discussion toward a factor he said is undervalued in trial design: quality of life. Dr. Karr agreed and introduced the concept of "time toxicity" — the burden that clinic visits themselves place on patients, particularly those with incurable disease, by taking time away from family or simply daily life. He contrasted a full eight-hour infusion day with newer subcutaneous bispecific formulations that let patients be in and out of clinic in about 30 minutes, arguing that treatment schedule and administration route deserve as much weight as efficacy when counseling patients. Dr. Kalantri connected this to the broader shift toward subcutaneous over intravenous administration and asked how that intersects with access, especially for patients who live far from academic centers.

Dr. Karr's answer pivoted to infrastructure: CAR T-cell therapy, despite now being second-line standard for multiple myeloma and large B-cell lymphoma, reaches only about 20% of eligible patients, largely because of the logistical burden — apheresis, potential bridging therapy, inpatient observation, and a roughly two-week requirement to stay near a certified treatment center. He noted that window has shrunk from about a month as centers gain experience managing cytokine release syndrome and neurotoxicity syndromes through premedication and earlier recognition, and that bispecifics, being off-the-shelf, are being adopted in community settings more rapidly than CAR T as a direct result of being logistically simpler to deliver.