At a recent Institute for Value-Based Medicine® event in San Francisco, the gap between new cancer treatments and the systems meant to deliver them was laid bare. UCSF and Stanford clinicians spoke bluntly. They said the way novel oncology therapies reach patients is broken. Science moves fast. The system lags behind. Patients lose out.
The biggest pain point right now? The 'brain-to-vein' bottleneck in CAR T-cell therapy. Vanessa Kennedy, MD, from Stanford, said the main hurdle is no longer the science or the lab. It's getting patients to the right clinic, at the right time. Edna Cheung, PharmD, BCOP, pointed to referral delays, not enough hospital beds, and the struggle to find local housing for patients who travel far. These problems block access. Cancellations pile up. Patients end up stuck on bridging therapy. The gap between what is possible and what actually happens keeps growing.
Nationally, about 1 in 5 patients eligible for CAR T-cell therapy never receive it due to travel distance, transportation barriers, or limited access to specialized centers.
It's not just CAR T. As bispecific antibodies and antibody-drug conjugates move up in treatment lines, new headaches appear. Mimi Lo, PharmD, BCPS, BCOP, described the scramble to get drugs, manage inpatient step-up dosing, and handle outpatient infusions. What drugs are on hand often decides the treatment sequence, not what is best on paper. Tian Yi Zhang, MD, PhD, said this is especially tough in acute myeloid leukemia. The disease is complex. There are few targets. Immunotherapy lags behind lymphoma. The panel agreed: patient navigators and clear referral paths are now essential.
In 2026, Mary Bird Perkins Cancer Center in Baton Rouge started the region's first fully outpatient CAR T-cell program for certain blood cancers. The program won the 2026 ACCC Innovator Award. Outpatient care is gaining ground. The Association of Community Cancer Centers (ACCC) now tells clinics to set up outpatient protocols for handling cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). They also urge clinics to add patient education and update electronic health records. Outpatient delivery is now a top priority. The goal is simple. Cut barriers. Get advanced therapies to more patients.
Trial design and what happens after a study ends came under fire in the next panel. Katherine Van Loon, MD, MPH, led the charge. Manali I. Patel, MD, MPH, MS, FASCO, shared how a Monterey County advisory board dropped prior authorization and found funding for biomarker testing. This made sure good interventions became standard care, not just a trial blip. Trever G. Bivona, MD, PhD, said CMS-covered diagnostics could help fill post-trial coverage gaps. Patient advocacy groups are pushing trial growth. But paperwork and slow sponsor payments burn out clinicians and strain community partners. The fix? Streamlined protocols and staff dedicated to travel reimbursement.
In Philadelphia, real-world practice varies: Penn Medicine and Alliance Cancer Specialists administer most step-up doses of bispecific antibodies in the outpatient setting, Jefferson Einstein does so exclusively outpatient, Thomas Jefferson University Hospitals uses a mixed approach, while Hackensack Meridian Health remains fully inpatient.
Breast cancer care shows the clash between new drugs and overtreatment. Laura Esserman, MD, MBA, called out the FDA's broad approval of trastuzumab deruxtecan (T-DXd) for all early HER2-positive patients. She warned that aiming to cure everyone can bring real harm. Lidia Schapira, MD, FASCO, raised the risk of fatal pneumonitis. Tiffany Meng, PharmD, said culture shapes prescribing as much as evidence. Esserman predicted that AI could soon help pathologists profile risk from slides. She wants less surgery after strong responses. The message is blunt. Precision should decide who gets therapy, for how long, and where. Not old habits.
These fights are not new. As reported earlier, the gap between what science can do and what clinics deliver keeps coming up in oncology. Logistical and system barriers block progress.
One thing is clear. Oncology's future will not be set by the next drug or device. It will depend on whether clinicians, payers, and policymakers are ready to break old rules and build systems that get the right therapy to the right patient, fast. Until the system and incentives catch up, precision oncology will stay out of reach. Patients will keep paying the price.
