Dr Marc Hoffmann on Bridging the Academic-Community Divide in Lymphoma

In the rapidly evolving landscape of cellular immunotherapy, chimeric antigen receptor (CAR) T-cell therapy represents a paradigm shift for patients with hematologic malignancies. However, despite its curative potential, a staggering disconnect remains between therapeutic availability and patient access. Current estimates suggest that up to 70% of eligible candidates never receive this treatment, often due to the geographic and logistical chasm between high-volume academic centers and community oncology practices.^1,2

In an interview with Targeted Oncology, Marc S. Hoffmann, MD, associate professor and director of the Lymphoma Program at the University of Kansas Cancer Center, discussed the access gap and the critical need for a more integrated care delivery model. From dismantling communication barriers during clinical hand-offs to rethinking the intense physical and financial burdens placed on caregivers, Dr Hoffmann explored how the oncology community can transition CAR T from a localized specialty service to a widely accessible standard of care.

Targeted Oncology: How can academic centers and community practices better collaborate to ensure patients stay close to home while still benefiting from complex therapies like CAR –T-cell therapy?

Marc S. Hoffmann, MD: I think this is probably the $10,000 question, right? I think that the biggest problem with CAR –T-cell therapy is not that it doesn't work. The biggest problem with CAR –T-cell therapy is the most generous estimates suggest that only about 25% or 30% of patients who should be getting CAR T or who are eligible for getting CAR T actually receive it. If we just simply optimize the number of patients that were receiving CAR T without even making our CAR T any better, we would probably close to triple the number of patients that are cured with large cell lymphoma.

Given that nearly 70% of eligible patients are missing out on these potentially curative treatments, what specific communication barriers between academic centers and community oncologists need to be broken down first to close that gap?

It's this access question as an issue. I think that both sides need to do a better job. I think the academic center—and this is me—need to do a better job of communicating to our external providers. How do you manage these patients in the early post CAR T period? How do we figure out how to ensure that these patients are coming back? We want to provide this service and then make sure that they get sent back to their community doctor, assuming that that doctor is still interested in continuing to care for them. We need to do a better job of that. That's just basic customer service stuff: communication, setting up expectations, making sure that protocols are disseminated, providing very clear guidance about how you do supportive care, and then making sure we do a very good job communicating and getting these patients back and forth.

Beyond the clinical hand-off between doctors, there is a massive logistical hurdle for the families themselves. How should we be rethinking the proximity requirements and the intense burden placed on caregivers during the recovery phase?

I also think we need to figure out ways to be more creative in terms of caregiver burden and understand who can be a caregiver. How can they be a caregiver? How long do these patients need to actually be observed? How long do they need to have somebody around? How long do they need to be in close proximity to the center? I think there are differences between the products that we need to highlight. Not all CAR –T-cell therapy is the same. Some of them have unusual, delayed toxicities that are not acute. They're problematic, but they're not something where you immediately need to drive to the hospital. Some CAR T cells have different types of toxicities where you better be coming to the hospital immediately, if you start to develop them…I do think that from an external standpoint, when our community providers know that CAR T cells are available for a patient, just understanding and sort of enthusiastically recommending that they do it. A really enthusiastic recommendation from a community physician goes way farther than anything I can tell them, right?

Since monitoring needs vary so much by product, how vital is it for the community oncologist—who has that long-standing trust with the patient—to be the one championing this complex path?

These are patients who are coming to me for the first time. They have an established relationship with their community oncologist. They usually have an excellent relationship. We need, on some level, some of their help in order to make sure that we're getting a real strident recommendation that this is the appropriate therapy for these patients.

Some of this is sort of bringing up old problems that we've had for a long time in terms of transplant referral patterns and cellular therapy. It turns out that the easy problems are hard and the hard problems are easy, right? We can figure out all these newfangled therapies for large cell lymphoma, but if we can't get them into the patient, we're not doing our job.

REFERENCES

1.Blue B. Socioeconomic and racial disparity in chimeric antigen receptor T cell (CART) therapy access. Transplantation and Cellular Therapy. Volume 28, Issue 7p345-346, July 2022.

2.Estrada E, Ardila V, Pereira D. Geographic distribution and racial disparities of CAR-T cell therapy centers in the United States. Transplantation and Cellular Therapy. Volume 32, Issue 2, Supplement, February 2026, Page S296. doi: 10.1016/j.jtct.2025.12.425.