Expanding CAR T-Cell Therapy in Community Oncology: A Critical Next Step for Access

Chimeric antigen receptor T-cell therapy (CAR T) has revolutionized oncology treatment over the last decade, offering targeted therapy options for several difficult cancers, especially hematologic malignancies, delivering durable remissions and high response rates.¹ Yet despite its efficacy, few eligible patients receive CAR T. Access remains concentrated in large academic centers, leaving many community-based patients to travel long distances or forgo therapy altogether.²

Community oncology is the key to closing this gap. With deliberate preparation, disciplined planning, strong hospital partnerships, and structured workflow design, community practices can deliver CAR T as safely and effectively as academic medical centers — bringing life‑saving therapies closer to home.

Why Local Access Matters

CAR T is often a one‑time therapy with the potential for deep, lasting remission.³ For patients already navigating complex cancer journeys, receiving treatment locally can minimize travel, reduce time away from family, and preserve continuity with trusted care teams. Yet logistical and operational complexity has left many community practices reluctant to implement CAR T programs, perpetuating disparities in who can receive treatment.⁴

Real-world experience now demonstrates that community implementation is both feasible and urgently needed.

A Community Blueprint: Lessons From Virginia Cancer Specialists

Virginia Cancer Specialists is the largest private cancer practice in Northern Virginia and part of The US Oncology Network, an organization of independent, community-based providers supported by McKesson.

After a year of operational planning, Virginia Cancer Specialists developed and launched a community-based CAR T program, providing a model for other practices interested in adopting this therapy.

How Community Practices Can Build a Successful CAR T Program

The team quickly learned that successful community‑based CAR T delivery requires more than infrastructure; it begins with a coordinated cultural shift across the practice. At Virginia Cancer Specialists, that shift started with early and active engagement from leadership. Physicians, executives, and operational managers came together to define the scope of the program, align on the personnel and infrastructure needed, and establish a realistic timeline. That collaborative foundation became essential as the team moved from concept to execution.

Once the commitment was secured, Virginia Cancer Specialists embarked on designing an end-to-end pathway that accounted for every step of a patient’s CAR T journey, from referral and eligibility confirmation to long-term follow-up. The team meticulously charted each transition, including coordination with the apheresis center, the manufacturer’s production timeline, and the exacting requirements for chain-of-identity and chain-of-custody. These details matter, as each manufacturer has highly specific expectations for how a practice handles frozen cells, verifies product identity, and follows thawing procedures. Ensuring pharmacy readiness is also a critical step, as it requires investment in ultracold storage, staff training, and careful documentation to meet certification standards.

Just as critical was assembling a multidisciplinary care team equipped to guide patients through what can be a complex, multi‑week process. Nurses, navigators, physicians, quality managers, and payer specialists each played a role in ensuring that no step was overlooked. Their ability to communicate, coordinate, and remain flexible proved central to the program’s success, particularly as the first patients moved through the pathway.

The final pillar was establishing a strong partnership with a local hospital. While many patients receiving CAR T can be managed in the outpatient setting, others develop cytokine release syndrome or immune effector cell-associated neurotoxicity syndrome, complications that require rapid intervention and, at times, intensive care. Virginia Cancer Specialists worked closely with hospital teams across neurology, infectious disease, cardiology, pulmonary medicine, and critical care to ensure they were fully prepared. The hospital’s readiness became a natural extension of the practice’s own program, offering a seamless safety net for patients experiencing high-grade toxicities.

Navigating Payer and Certification Challenges

Even with clinical and operational readiness in place, payer navigation quickly emerged as one of the most complex barriers to timely CAR T delivery in the community setting. Early engagement, precise documentation of eligibility, and proactive coordination with manufacturers proved essential to avoiding delays that could jeopardize patient outcomes.

Best practices for CAR T payer engagement are still evolving. Even CAR T–certified practices may not be able to deliver therapy across all payer types, as some commercial insurers restrict where treatment can occur. Government payers, by contrast, may offer more flexibility in site‑of‑care decisions.

As a result, success in community CAR T programs depends heavily on staff who are deeply invested in the logistics and financial mechanics of care delivery — areas where physicians may have limited visibility, but where delays can directly affect access and outcomes.

Through this careful, collaborative, and comprehensive approach, Virginia Cancer Specialists built a CAR T program capable of matching the clinical rigor traditionally associated with academic centers while maintaining the accessibility and patient-centered approach that define community oncology.

Early Patient Experiences at Virginia Cancer Specialists

After a year of preparation, Virginia Cancer Specialiststreated its first patients with CAR T-cell therapy in the fall of 2025: a healthy 68-year-old man with aggressive and early recurrent diffuse large B-cell lymphoma (DLBCL). The patient had received chemoimmunotherapy but demonstrated very early relapse within 12 months. Multiple clinical trials show CAR T is preferable over salvage chemotherapy and transplantation for patients in this situation,⁵ establishing it as the preferred second-line standard of care for early relapse.

The patient was offered CAR T therapy for his DLBCL, and after seeking another opinion from an academic center, he elected to receive treatment at Virginia Cancer Specialists. The team administered the therapy and monitored the patient closely, managing all side effects in the outpatient setting and avoiding hospitalization. Fortunately, the desired outcome was achieved, with PET/CT surveillance imaging demonstrating a complete response and remission. To date, the patient is doing well and remains disease-free several months after CAR T.

Another patient in her 70s had very aggressive multiple myeloma after receiving several therapies, including prior bispecific antibody treatment. Unfortunately, disease progression continued, with rapidly worsening disease kinetics, reflected by a sharp rise in serologic markers of myeloma. Specifically, her lambda light chain levels increased from approximately 900 to nearly 10,000.

The team arranged for her to receive CAR T, and despite some delays, she ultimately underwent treatment in late November 2025.

Unlike the first patient who did well with minimal toxicity, this patient experienced significant toxicities with both cytokine release syndrome and immune effector cell–associated neurotoxicity syndrome, requiring hospitalization for severe symptoms. With the help of the knowledgeable hospital team, as well as Virginia Cancer Specialists’ near-daily involvement, the patient’s acute CAR T associated toxicities were successfully managed. Today she is doing well with a good quality of life with evidence of ongoing remission.

Together, these cases reflect the full toxicity spectrum and demonstrate that a well-prepared community practice can effectively manage both routine and high-acuity CAR T experiences.

Localizing Access to Advanced Therapies

Bringing CAR T closer to patients is more than an operational achievement — it is a critical step toward democratizing advanced cancer therapies and ensuring every eligible patient has the opportunity for the best possible outcome.

Virginia Cancer Specialists’ experience shows that with careful preparation, community practices can deliver CAR T safely, effectively, and sustainably. As indications expand and outpatient management improves, community oncology will play a central role in ensuring equitable access to cutting‑edge cellular therapies.

REFERENCES

1. Arjumand S, Raj A, Prattay KMR, Omer HBM, Azam F. Chimeric antigen receptor T cell therapy: Revolutionizing cancer treatment. World J Clin Oncol. 2025;16(11):108667. doi:10.5306/wjco.v16.i11.108667 .

2. Blevins Primeau A. Access to CAR-T Therapy Challenging in Community-Based Transplant, Cell Therapy Networks. Hematology Advisor. March 17, 2025. https://tinyurl.com/a9x2vy29.

3. Cappell KM, Kochenderfer JN. Long-term outcomes following CAR T cell therapy: what we know so far. Nat Rev Clin Oncol. 2023;20(6):359-371. doi:10.1038/s41571-023-00754-1 .

4. Chung AP, Shafrin JT, Vadgama S, et al. Inequalities in CAR T-cell therapy access for US patients with relapsed/refractory DLBCL: a SEER-Medicare data analysis. Blood Adv. 2025;9(18):4727-4735. doi:10.1182/bloodadvances.2024015634

5. Testa U, Leone G, Pelosi E, Castelli G, Hohaus S. CAR-T Cell Therapy in Large B Cell Lymphoma. Mediterr J Hematol Infect Dis. 2023;15(1):e2023066. Published 2023 Nov 1. doi:10.4084/MJHID.2023.066