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    CAR T-cell therapies in treating lymphoma: Pros and cons


    MHE: How would you like payers to pay for the CAR T-cell therapies?

    Bollard:  CAR T-cell therapies have remarkable potency, and we’re seeing that in the patients who have already relapsed, in some cases, up to 10 times. The cost of that alone—treating a patient with 10 lines of therapy—is a lot. The CAR T-cell approach could be brought up early in the treatment process as the initial therapy.

    If we could bring CAR T-cell therapies into the disease treatment process much earlier, that would be remarkably cost effective. Then you wouldn’t be dealing with all the relapses. If you treat patients early in their disease process, the toxicity is much less as well; that means the cost of managing the toxicity would be reduced.

    Now that the Novartis product has been approved by the FDA, the pharmaceutical company’s next clinical trial will bring that therapy out much earlier in the disease process.

    If I were a drug company developing a CAR T-cell therapy, I would look at my competing therapy and make sure my new therapy doesn’t cost significantly more. And in this instance, the best competing therapy is a bone marrow transplant, which is relevant for acute lymphoblastic leukemia (ALL).

    MHE: Tell me more about the antigen-specific T cells and how they work.

    Bollard: We don’t genetically modify these cells. We basically train the cells in the laboratory to recognize the different tumor proteins expressed by the tumor cells. We started with the Epstein-Barr virus (EBV)-associated lymphomas; these are lymphomas that develop in patients, even after bone marrow transplants, solid organ transplants, or in immunocompetent patients.

    The response rate using EBV-specific T-cells is up to 90%, depending on the patient group. We can move this to an off-the-shelf product because there are multiple studies that have used banks of these T-cells; they have shown remarkable safety and efficacy. This has not been shown when that strategy was tried with CAR T cells.

    MHE: What are the advantages and disadvantages of both therapies?

    Bollard: The CAR T cells are much more expensive, and they require much more modification. The antigen-specific T cells are cheaper and there’s no genetic modification.

    That means the CAR T-cell approach is complex and requires a lot of regulatory oversight. The antigen-specific T cells don’t require regulatory oversight because there’s no gene modification.

    But there’s no doubt that the CAR T cells are showing remarkable efficacy in a patient population without many options. On the other hand, the antigen-specific T cells have shown efficacy but these are in a much smaller number of trials—and without significant support from big pharmaceutical companies.

    Finally, the CAR T cells are associated with life-threatening toxicities. The antigen-specific T cells have a severe toxicity rate of 1.2%.

    MHE: Is cost as much of a factor with the antigen-specific T cells?

    Bollard: None of these products have been licensed. The academic cost of manufacturing a CAR T cell is $18,000, and the cost to generate an antigen-specific T cell is about $8,000.

    Because the antigen-specific T cells are more cost effective, they may be more attractive to payers. There are some pharmaceutical companies embracing this therapy, but they’re lagging behind the CAR T-cell therapies.


    Aine Cryts
    Aine Cryts is a freelancer based in Boston. She is a frequent contributor to Managed Healthcare Executive on topics such as diabetes, ...


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