Loretta J. Nastoupil, MD

Several differences arise between community oncology centers and institutional oncology centers regarding the tools available and requirements of patients with cancer.

Often, patients in middle-income settings, are the patients who are impacted most by insurance deductibles, according to Loretta Nastoupil, MD.

Over the past 10 years, more barriers have become apparent in the process of getting insurance companies to approve cancer treatments, according to Loretta Nastoupil, MD.

Although institutional cancer centers boast large amounts of resources, community centers do not always have the resources to initiate clinical trials, according to Loretta Nastoupil, MD.

The consolidation of oncologists and the transition to bispecific antibodies and CAR T-cell therapies are among factors that have led to increasing cancer care costs.

Panelists review a patient with relapsed LBCL presenting with symptomatic disease and logistical barriers to treatment access. The discussion highlights how proximity to treatment centers, work demands, and concerns about toxicity influence therapy selection. Faculty consider practical approaches to balancing efficacy, access, and quality-of-life considerations.

Panelists evaluate a young patient with early relapsed LBCL following frontline therapy who is curious about CAR T. Discussion focuses on high-risk disease features, long-term treatment goals, and considerations such as family planning and treatment durability. Faculty debate how these factors influence selection of second-line therapy.

Panelists discuss strategies to improve access to CAR T therapy and optimize delivery across treatment settings. Key considerations include referral timing, coordination between community and academic centers, and the potential role of outpatient CAR T programs. Faculty explore how infrastructure, logistics, and multidisciplinary collaboration affect real-world access to therapy.

Panelists debate optimal second-line treatment strategies for patients with relapsed/refractory LBCL. The discussion explores decision factors such as patient fitness and lifestyle, disease biology, timing of relapse, and transplant eligibility when selecting between CAR T-cell therapy and transplant-based approaches. Faculty weigh evolving evidence alongside practical considerations influencing treatment sequencing.

Panelists analyze real-world outcomes for patients receiving CAR T therapy in LBCL using US electronic medical record data from Flatiron Health. Discussion highlights differences and similarities in survival outcomes, safety events such as CRS and neurotoxicity, and healthcare resource utilization in outpatient settings for two key CAR T products. Faculty consider how these findings compare with clinical trial data and inform real-world treatment expectations.

Panelists discuss real-world treatment patterns for relapsed/refractory LBCL using the Flatiron Health electronic health record database. The conversation examines shifts in second- and third-line therapy use following CAR T approval, including declining reliance on salvage chemotherapy and transplant.

Panelists review the final analysis of the ZUMA-7 study evaluating axi-cel versus salvage chemotherapy followed by transplant. Discussion focuses on long-term event-free survival, progression-free survival, and overall survival outcomes. Faculty also assess the safety profile and implications for positioning CAR T as a preferred second-line strategy.

Panelists discuss long-term outcomes from the TRANSFORM study evaluating liso-cel in second-line relapsed/refractory LBCL. The conversation highlights durability of response, progression-free and overall survival trends, and updated safety findings presented at the American Society of Hematology Annual Meeting 2025. Faculty consider how extended follow-up informs expectations for long-term remission with CAR T therapy.

Balancing the goal of obtaining a durable remission and that of avoiding a negative impact on quality of life argues against the routine use of chemotherapy in follicular lymphoma.

The rationale for maintenance therapy in indolent non-Hodgkin lymphoma was derived from historical data suggesting that despite robust response rates to standard therapy, most patients eventually relapse and disease-free intervals become progressively shorter.

This review will cover innovative therapeutic approaches in relapsed or refractory MCL, many of which have the potential to alter treatment paradigms toward the development of strategies that do not involve conventional chemotherapy agents.

This article examines clinical and biological features of DLBCL patients with poor outcomes, and reviews recent studies addressing alternatives to standard front-line management strategies together with unresolved questions.