Nationwide network of CAR-T treatment centres

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Patients and clinicians await news of whether the government will extend the funding of Novartis' CAR-T therapy KYMRIAH (tisagenlecleucel) to include diffuse large B-cell lymphoma (DLBCL) in adults.

The Medical Services Advisory Committee is reconsidering extending access having recommended it be funded for the small number of children and young adults with B-cell acute lymphoblastic leukaemia (ALL).

It previously deferred a decision on DLBCL and, in doing so, highlighted a number of issues that would need to be addressed. 

Some of those issues related to the nature of emerging evidence, related uncertainty and the potential cost, but MSAC also identified the need for more treatment centres.

The number of patients with DLBCL who might qualify for funded access to KYMRIAH is thought to be in the hundreds, compared to just a few dozen with ALL.

MSAC recognised the potential size of the DLBCL patient group and the need to widen access beyond the current treatment centres in Sydney and Melbourne.

"For the DLBCL population, it was suggested that a centre would subsequently be required in every state due to the larger patient numbers," it said.

Funding expansion of the treatment centre network is complex with the cost likely to be shared by the company, federal, state and territory governments.

There is also the consideration of needing to establish a nationwide network of centres capable of treating potentially several thousand patients every year as more CAR-T and other new technologies emerge from company pipelines.

In a statement, Novartis said it will work with federal, state and territory health authorities, and that it "plans to on-board additional tertiary hospital treatment sites within the next 12 months to ensure sufficient treatment capacity and geographic equity of access for Australian patients."

However, it also noted the "timing of expansion will be dependent upon public funding of the DLBCL indication as well as site readiness to comply with regulatory standards."