How I Approach Ethical Considerations for Pediatric Phase I CAR T-Cell Trials

Phase I trials of chimeric antigen receptor (CAR) T cells have shown remarkable promise in pediatric B-cell malignancies. Such outcomes have shifted expectations for other phase I CAR T-cell trials to have high response rates. The juxtaposition of high expectations, uncertain outcomes, and potential for life-threatening toxicities raises unique ethical considerations. To aid patients and providers considering early-phase CAR T-cell trials, we discuss: (i) considerations for enrollment of pediatric patients, (ii) understanding trial intent and expectations, (iii) weighing risks and benefits, (iv) considerations for informed consent discussions, (v) post CAR T-cell therapy expectations, (vi) barriers to access, and (vii) vulnerability in decision making.