Overcoming challenges in the implementation of chimeric antigen receptor (CAR) T-cell therapy in resource-constrained settings: Lessons from Brazil and India.

Abstract

Advances in immunotherapy, including chimeric antigen receptor (CAR) T-cell therapy, have achieved remarkable outcomes in treating relapse/refractory hematologic malignancies. However, despite the broad adoption of cellular immunotherapy in resource-rich countries such as the United States, Europe, and China, access remains limited in countries with fewer resources. The high cost and many requirements to implement CAR T-cell therapy further exacerbate pre-existing disparities in access to costly therapies. In this review, we discuss specific barriers limiting the widespread adoption of CAR T-cell therapy in resource-constrained settings, with a focus on emerging economies such as Brazil and India, including regulatory and implementation aspects, health care infrastructure, government investment, and geographic and social disparities. We also address unique limitations to implementing CAR T-cell therapy in the pediatric setting. Lastly, we highlight alternative solutions to overcome challenges and report the initiatives adopted by Brazil and India that aim to make CAR T-cells more accessible. These efforts, supported by partnerships with academic institutions, international collaborations, and biotechnology companies, focus on expanding access and developing a cost-effective product.