We have been waiting for long-term survival data from a pricey new immunotherapy called CAR-T. That stands for chimeric antigen receptor T-cell therapy. Patients donate blood so that their white blood cells, known as T cells can be taught to recognize and attack their cancer cells. Preliminary results looked promising, but the real test of new cancer treatments is long-term survival. That’s why cancer experts are excited about data just presented at the annual meeting of the American Society of Hematology and published in two eminent journals.
Yescarta (Axicabtagene) and Kymriah (Tisagenlecleucel) vs. B Cell Lymphoma:
Researchers announced promising new results from immunotherapy against B-cell lymphoma in the New England Journal of Medicine (online, Dec. 1, 2018) and Lancet Oncology (Dec. 2, 2018). In both studies CAR-T therapy achieved impressive results for 40 percent of patients. Each treatment produced durable remissions that were dramatically better than conventional therapies.
The lead author of the ZUMA-1 clinical trial, Frederick Locke, MD, shared these thoughts about the CAR-T treatment Yescarta:
“This therapy has been a game-changer for patients with large B cell
lymphoma who have failed two or more lines of therapy. Our ZUMA-1 clinical trial data show durable response beyond 2 years for nearly 40 percent of patients who had almost no chance for complete responses with conventional chemotherapy.
“Importantly, ongoing remission 2 years after initial chemotherapy for large B cell lymphoma is predictive of a cure, giving us hope that lymphoma will never return for many of the patients remaining in remission 2 years after axicabtagene ciloleucel.”
The other CAR-T study was published in the New England Journal of Medicine. It was called JULIET. One of the co-authors, Michael Bishop, MD, shared his optimism about Kymriah:
“Overall, this is extremely exciting. Relapses after 12 months are infrequent. Our first patient, treated in May 2016, has been back at work for two and a half years. This trial demonstrates that CAR-T cell therapy can provide a high rate of durable responses.”
Why CAR-T Immunotherapy is Important:
What makes these two studies so remarkable is that the patients who were selected were on their last legs. That is to say they had been treated with traditional therapies and had relapsed. When B cell lymphoma patients fail standard treatments the hope for remission is usually pretty slim.
Roughly 40 percent of patients in both trials had a complete response to CAR-T therapy. We would consider that an important advance if not a breakthrough.
The Downside of CAR-T Therapy:
The cost of CAR-T immunotherapy will take your breath away. Gilead, the drug company that manages Yescarta treatments, has listed this immunotherapy at $373,000. That does not take into account many ancillary costs, especially those involved in hospitalization for complications.
The price of Kymriah from Novartis is listed at $475,000 for a single infusion. Ancillary costs because of other hospital treatments could easily boost that over $500,000.
Can insurance companies afford such treatments? What about the Medicare, Medicaid or the Veterans Administration. Those are your tax dollars at work. We are grateful to have such innovative and successful cancer treatments coming online. The question we will have to answer as a society is can we afford them?