CAR-T therapy is an incredibly powerful and relatively new form of cancer treatment through synthetic biology. As these treatments begin to win Food and Drug Administration (FDA) safety approval, the need for oversight and ethical debate continues to grow. Ethical concerns cover both human research subjects and patients undergoing cancer treatments with these new therapies. CAR-T therapy was once considered a “last resort” effort in cancer treatment, but is now becoming more mainstream due to the extreme effectiveness of some treatments. Ethical concerns include both equitable distribution of treatment along financial and geographic lines, and managing patient expectations of these high-demand treatments.
Chimeric antigen receptor T-cell (CAR-T) therapies have experienced some of the same ethical concerns as previous cancer cell therapies. These include long waiting lists for trials or treatment, worries over reimbursement and very few locations offering CAR-T therapy. Excitement among the medical and pharmaceutical industries remains high despite these initial problems. Major investments in blood cancer and solid tumor CAR-T therapies are ensuring that they will become even more mainstream in the years to come.
CAR-T therapy is a treatment that carries more serious ethical concerns than other treatments, due to its novelty. Researchers have to identify appropriate patient populations, formulate appropriate consent strategies, manage adverse events, identify the correct endpoints to gauge effectiveness of the treatments, and more.
Emphasizing equity in clinical CAR-T therapy trials means ensuring fair access to the benefits, instead of ensuring fair distribution of risks. The demand for slots available in clinical trials is greatly exceeded by the number of available slots. Ethics researchers say this runs the risk of privileging some groups over others in clinical trials. Many patients involved in CAR-T therapy trials have had their lives saved by these highly effective treatments, or at least greatly extended their lifespan compared to those who have not received treatment.
The effectiveness of CAR-T therapy has placed it in high demand as a treatment, with very few slots available due to cost and other concerns. The hype for the treatment can lead to ignoring the benefit to risk profile of these powerful therapies, which can vary greatly among patients and by indication.
Bioethicists recommend that clinical trial creators take both potential risks and benefits into consideration for the sake of equity. Trials should also clearly explain the nature of the experimental treatments clearly, the target patient population, and the percentage likelihood of the risks and benefits.
Another concern is that, since cancer patients are clamoring for access to these treatments, doctors must take compassionate care into consideration. New CAR-T therapy treatments are often granted expanded access for patients with serious or life-threatening conditions, but who may not qualify for participation in clinical trials. The Food and Drug Administration (FDA) approves almost every expanded access request that it receives. However, approval does not make it mandatory for firms to supply treatment to every patient requesting it. This could change at some point in the future due to congressional action.