‘How do you decide?’: Cancer treatment’s CAR-T crisis has patients dying on a waitlist

Within two years of being diagnosed with multiple myeloma, Shawn Goltzene had blasted through nearly all his options. An initial stem cell transplant couldn’t hold off the cancer for more than half a year. With each new therapy his doctors tried, the cancer would surge out of remission within weeks — striking the bones in his back and legs.

“We hit him with everything, the whole kitchen sink,” said Krina Patel, the director of the myeloma cell therapy program at MD Anderson Cancer Center and Goltzene’s clinician. She tried putting him on a clinical trial for an immunotherapy drug. “It blew right through him. He quickly got to fourth-line therapy.”

By the fall of 2021, Patel saw only one possibility left to save Goltzene’s life — a newly approved CAR-T cell therapy for myeloma. In clinical trials, this type of personalized immunotherapy had shown remarkable efficacy in patients with stubborn myeloma, offering them months or years of healthy life that they would never have otherwise experienced. Goltzene was about to become eligible to receive it, but Patel had to warn him that being eligible wasn’t enough. They would have to make their case for something all too rare: a cell-manufacturing slot.

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