Cheaper CAR-T: Perhaps some good news on a cold rainy November day?

[Me2AsWell]

A new device accelerates the production of tailor-made chimeric antigen receptor (CAR) T-cell therapies. This innovation is a stride towards cost-effective manufacturing of personalised treatments, slashing the cost to approximately $30,000, a steep decline from the $475,000 benchmark set in 2017.

whyy.org/segments/chops-on-...

[neurodervish]

Wow, this seems like medicine out of a Star Trek episode! Who knows, maybe in the future, the machine will be smaller and won't need 2 weeks to convert T-cells into CAR-T cells.

I ran a search to see what other info might be available about the CliniMACS Prodigy machine and found this video from 4 yrs ago: youtube.com/watch?v=PFWoVN5...(Not working as expected?)

Then I found an updated video from 3 yrs ago, which stresses a more automated process (which I found strangely reassuring): youtube.com/watch?v=nEqGTx9...(Not working as expected?)

[Skyshark]

I'm not so welcoming. CAR-T is currently a 4th or 5th line therapy after all others have failed. This price puts it well into contention to be the primary first line treatment. It's preceded by a round of high dose Bendamustine for lymphodepletion. That puts us back to mustard gas based chemo for everyone, something I feel is the last resort.

[LeoPa in reply to Skyshark]

A few days ago there were two posts about how CAR-T can cause T cell cancers or something. So I don't think it is going to be a first line treatment anytime soon. But as a last resort treatment, it will at least be affordable to more patients than until now if it is cheaper which is a good thing.

[AussieNeil Administrator in reply to LeoPa]

Please, let's read about what has been found "from clinical trials and postmarketing adverse event data sources", along with some factual information and keep this in perspective.

FDA Investigating 'Serious Risk' of Malignancy After CAR-T Therapy - Applies to all approved therapies, but benefits still outweigh risks

healthunlocked.com/cllsuppo...

which includes the following, 'In response to the FDA safety notice, Bristol Myers Squibb (BMS) issued the following statement:

"Bristol Myers Squibb has treated more than 4,700 patients across clinical and commercial settings with Abecma and Breyanzi, which use only lentiviral vector. To date, BMS has not observed any CAR-positive T-cell malignancy cases and therefore, we have not found a causal relationship between our products and secondary malignancies."

"Patient safety is a top priority for BMS, and we remain confident in the safety profile and clinical value of our cell therapies," the company continued. "We are collaborating with the FDA in its ongoing investigation and are responding to FDA's requests for information."'

Preconditioning for CAR-T uses alklyating agents, which can come with a higher risk of secondary cancers. If the risk is found to be unacceptably high and the preconditioning thought to be responsible, perhaps using the likes of venetoclax might reduce the risk. The challenge is that this involves a trade off in time to get an aggressive cancer under control.

Neil

[LeoPa in reply to AussieNeil]

Thanks! Would you opt for CAR-T as a first line treatment if it cost 30K (knowing what you know) or would you still start with a BTKI?

[AussieNeil Administrator in reply to LeoPa]

LeoPa, it's an individual decision based on each person's determined specific risk/reward assessment. For CLL, I would consider CAR-T to still be experimental. See this review; CAR-T Cell Therapy for Chronic Lymphocytic Leukemia: Successes and Shortcomings from May 2022 ncbi.nlm.nih.gov/pmc/articl...

However for some who have exhausted proven treatments, it can offer years of drug free remission. Two of the three initial CAR-T CLL clinical trial participants managed 10 year remissions. One sadly succumbed to COVID-19. They had exhausted other options at the time.

Neil