CAR-T therapies are transforming outcomes for some cancer patients, offering hope where few options remain. However, ensuring more people can benefit from these treatments is a growing challenge.
What is CAR-T?
Cell and gene therapies (CGTs) represent a new wave of transformative cancer treatments, delivering remarkable outcomes for patients. Among these, chimeric antigen receptor T (CAR-T) therapies are at the forefront. CAR-T works by taking a patient’s own immune cells, modifying them in a lab to recognise and attack cancer and then returning them to the body.
These personalised treatments are designed for patients with blood cancers that no longer respond to conventional therapies. In some cases, CAR-T has delivered lasting remission where disease was once considered incurable.
The challenge of cost and complexity
However, this promise comes with significant challenges. CAR-T therapies can cost over £300,000 per patient, with additional hospitalisation costs of £1,000 to £2,000 per day.
These costs reflect the complexity of manufacturing and clinical delivery, as well as the highly personalised nature of each treatment.
This creates real pressure for publicly funded healthcare systems such as the NHS, where affordability and access remain key concerns. But cost is only part of the picture. Delivering CAR-T involves a complex pathway spanning clinical care, manufacturing, logistics and long-term monitoring, challenges that no single organisation can address alone.
The FAST CAR-T consortium
This is what the FAST CAR-T consortium aims to tackle. Funded by EPSRC and led by UCL, the project brings together researchers from Teesside University, the Royal Free Hospital London and Bristol Business School at UWE to explore barriers to CAR-T delivery and how they can be overcome.
As part of this work, the consortium runs workshops that bring together experts from across the CAR-T ecosystem. These sessions focus on shared barriers, what is needed to scale these therapies and how stakeholders can work together more effectively.
Key insights from the workshop:
Our most recent workshop, hosted at UWE Bristol, brought together 50 participants from over 18 organisations to focus on clinical delivery, workforce and system readiness.
A clear theme was the growing complexity of the therapy landscape. While CAR-T remains central, new approaches such as tumour-infiltrating lymphocytes and regulatory T-cell therapies are expanding into solid tumours, autoimmune diseases and rare conditions.
A complex system around the patient
CAR-T delivery involves multiple stages, from patient identification and cell collection through to manufacturing, infusion and long-term follow-up. Patients may undergo weeks of treatment, including chemotherapy and extended hospital stays.
This is not just clinically complex, it also places pressure on healthcare services, from bed capacity to specialist staff and coordination across teams. As one participant put it,
“this is not a single intervention, it’s an entire system wrapped around a patient.”
The interface between clinical care and manufacturing remains a key challenge. Ensuring chain of identity and chain of custody is essential but logistically demanding, often involving multiple organisations. Limited visibility across the pathway can also make it difficult to identify and resolve issues.
Workforce and infrastructure pressures
Delivering CAR-T requires highly specialised expertise across clinical, manufacturing and pharmacy teams, yet this capability is not evenly distributed. Pharmacists are increasingly involved but may lack formal training in areas such as immunology or cell biology. As demand grows, both training and retention are becoming more challenging.
Infrastructure is another constraint. Even as manufacturing capacity increases, clinical delivery may become the limiting factor. Many centres are already working within limits, whether in bed capacity, specialist facilities or staffing.
At a system level, fragmentation also creates inefficiencies. Different digital platforms, complex contracting processes and regulatory requirements can all slow progress, highlighting the need for greater coordination and standardisation.
What needs to change?
Despite these challenges, several practical solutions emerged from the workshop. The hub-and-spoke model was widely discussed, with specialist centres delivering complex care and regional centres supporting follow-up. This could expand access without duplicating infrastructure.
Participants also highlighted the value of simple improvements such as standardised checklists, shared training and better data transparency.
Digital innovation offers further opportunities. Remote monitoring, wearable technologies and integrated data platforms could improve patient management while reducing pressure on hospitals.
There was also strong support for new hybrid roles and enhanced training pathways to address skills gaps across the system.
Looking ahead
Cell and gene therapies such as CAR-T represent the next generation of advanced medicines, with the potential to deliver more targeted and effective treatments.
However, expanding access is not just a scientific or clinical challenge, it is a systems challenge.
Without change, these therapies may only reach a small proportion of the patients who could benefit.
The next phase of the FAST CAR-T project will focus on translating these insights into practical recommendations and scalable delivery models.
As these therapies continue to evolve, so must the systems that support them. CAR-T has the potential to transform outcomes, but can healthcare and manufacturing systems keep pace and deliver equitable access for patients?
