CT-452 Outpatient vs Inpatient Administration of Chimeric Antigen Receptor (CAR) T-Cell Therapy in Cancer Patients: Systematic Literature Review

• Published in: Clinical lymphoma, myeloma and leukemia myeloma and leukemia, 2023-09, Vol.23, p.S531-S531
• Main Authors: Hansen, Doris, Liu, Yi-Hsuan, Ranjan, Sandip, Bhandari, Hitesh, Potluri, Ravi, McFarland, Lindsay, de Braganca, Kevin, Huo, Stephen
• Format: Article
• Language: English
• Subjects: CAR T; cost; effectiveness; outpatient administration; quality of life
• ISSN: 2152-2650; 2152-2669
• DOI: 10.1016/S2152-2650(23)01517-3

CAR Ts are typically administered as an inpatient treatment, with patients being monitored closely after infusion for serious side effects, such as cytokine release syndrome (CRS) and neurotoxicity (NT). Recent studies have explored CAR T administration in an outpatient setting to potentially reduce the treatment burden for patients and caregivers, as well as the overall cost burden to the healthcare system. We aimed to compile clinical, humanistic, healthcare resource utilization, and cost outcomes of patients treated with CAR T in the outpatient setting and compare these to the inpatient setting where feasible. A systematic literature search was conducted in Medline, Embase, and Cochrane library to identify publications published between January 1, 2016 and January 4, 2023 that reported relevant outcomes in patients treated with any CAR T therapy in the outpatient or inpatient setting. No restrictions were placed on the type of cancer or nature of study. Of 7,701 records retrieved, 1208 met the inclusion criteria. Thirty-eight records (based on 12 clinical trials involving lisocabtagene maraleucel and tisagenlecleucel, and 9 observational studies) reported data in the outpatient setting. Eleven (5 clinical trials) of these 21 studies also reported data in the inpatient setting. Patient populations identified from the included studies covered 6 types of hematologic cancers. However, patients were not randomized to the settings – it was chosen at investigator's discretion with patient circumstances/preference being taken into account. Overall response rates were found to be comparable among patients managed in the outpatient setting compared to those managed in an inpatient setting. Duration of response, progression-free and overall survival data reported showed outcomes to be similar. No statistically significant differences were observed in change in quality of life, assessed by EORTC-QLQ-C30 and EQ-5D-5L, between patients managed in the 2 settings. Rates of CRS and NT were comparable in most studies. Six-month post-infusion costs were 2–4 times greater in the inpatient setting, ranging from $62K–$96K. While CAR Ts are typically administered in inpatient settings for patients with cancer, outpatient administration of CAR Ts can reduce the economic burden without impacting overall outcomes in effectiveness, safety, and quality of life.