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Expert Interview

Slingshot members are talking to an expert! The topic is:

Edison will be hosting a call to discuss the delivery challenges and potential solutions to administering CAR-T therapies more widely upon eventual FDA approvals.

Ticker(s): JUNO, KITE, CELG, NVS

Who's the expert?

Name: Dr Rafael Bejar - MD/ PhD

Institution: UCSD Moores Cancer Center

Bio:

  • Board certified internal medicine, oncology, and hematology, Dr. Bejar specializes in the care of patients with myelodysplastic syndromes (MDS) and related blood disorders.
  • Established a MDS Center of Excellence at UC San Diego Health focused on providing the best diagnostic tools, supportive care, clinical trials, and medical expertise in one center. Currently sees ~8 patients a week with MDS as well as inpatient obligations.
  • Previously worked in the community hospital setting as an internal medicine resident (Faulkner Hospital in Boston), Dr. Bejar is able to speak about the challenges of CAR-T cell administration in that setting.

Interview Questions
Q1.

Please describe your background for us, including the types of facilities you see patients and your experience /knowledge of CAR-T therapies in development.

Added By: joe_mccann
Q2.

When looking at the current CAR-T therapies in development, please walk us through the high level challenges you would see arising in treating patients at your facility.

Added By: joe_mccann
Q3.

How many specialists do you think would be required at a minimum to monitor a patient undergoing treatment? How much of a challenge would this be in most hospital settings?

Added By: joe_mccann
Q4.

From a logistical perspective, what % of patients in the US would have a difficult time receiving therapy? Please discuss this from the point of view of traveling for check-ups, number of facilities that can actually offer treatment and any other considerations you think we should have in mind.

Added By: joe_mccann
Q5.

Timing of therapy:  In the trials you've been involved in, what is the typical amount of time it takes from when a patient undergoes the leukapheresis until they are infused with the reprogrammed T cells?

Added By: mbritz
Q6.

One of the common side effects that we hear about in CAR T trials is neurotoxicity.  Can you tell us about your experience in how neurotoxicity presents itself in these patients.  Do you this the neurotoxicity will be common to all CAR T therapies or do you think it is specific to the target?

Added By: mbritz
Q7.

Pretreatment - Do you think pretreatment with cyclophosphamid/fludarabine is or will be required for all CAR T therapies?  How does this pretreatment affect the challenge of delivery of CAR T therapies - is it a minor inconvenience or a major problem?

Added By: mbritz
Q8.

What are some of the challenges that will need to be faced as CAR T moves from targeting blood cancers to solid tumors?  Do you think CAR T shows promise for treatment of solid tumors?

Added By: mbritz
Q9.

Can you compare and contrast the manufacturing and delivery issues of allogeneic CAR-T therapies vs autologous CAR-T therapies and your view on the impact to auto-CAR's in allo-CAR's turn out to be successful in the clinic?

Added By: bioinv
Q10.

What is the advantages and disadvantages of CAR-T therapy versus Dendritic Cell vaccine?

Added By: lancasterca
Q11.

What is an estimated cost for CAR-T therapy?  Would it be priced differently for different approved indications (i.e. DLBCL vs. ALL)?  Do you think it will be used as a bridge therapy to transplants?

Added By: user40993375
Q12.

Currently CAR T therapies are administered in the hospital setting (often in large cancer centers in major metropolitan centers.  Can you envision a scenario where apheresis collections or treatments could take place in smaller regional hospitals or perhaps blood centers? 

Added By: mflo

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