The People's Perspective on Medicine

CAR-T Immunotherapy Produces Stunning Results vs. B Cell Lymphoma

People who have failed traditional treatment for B cell lymphoma have few options. But two new studies report that CAR-T immunotherapy offers new hope.

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.

ZUMA-1 Results:

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.”

JULIET Results:

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?

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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There is no “cure” for cancer when the causes of cancer are pervasive in our environment. This includes food additives, chemicals in personal products and household cleaners, artificial fragrances, and poisons in the soil, air, and water. The only real cure is prevention, but the greed and lack of self-regulation in industry, the complicit behavior of legislators, and the blind eye of the FDA fuels the onslaught of misinformation to the American public. Yes, we have the ability to make healthier choices that support health and wellness, but belief in a real cure for cancer is wishful thinking.

What are the chances of CAR-T becoming a first line treatment rather than waiting until a patient is virtually on his death bed? If so, and assuming it worked for “early” cancer diagnosed patients, it could be used much more often and that would not only save lives and suffering, let alone the initial chemo and xray and surgery expenses first incurred, but the frequency of use perhaps would significantly reduce the cost per patient.

Yes, the prices for drugs are really insane.
I’ve been on Enbrel for 20 years and you would think that the price would go down. No! It has gone up, close to $5,000 a month.
And now I have been diagnosed with cancer, CLL. The doctor said Imbruvica would be the drug of choice to use in treating CLL. Well, that drug costs $12,000 per month, or 144,000 per year! And it is NOT a cure, you must be on it forever. And of course it has many terrible side effects. No thanks, I’ll pass. I decided to let the CLL run its “natural course”.
The entire drug industry is draining America. These extreme costs for drug treatments cannot be sustained.

I believe no doctor or hospital should EVER accept anything other than direct payment from those treated. Dealing with insurance companies and the government causes costs to skyrocket for all except the insurance companies. It’s a nightmarish racket.

I would like to know if these companies got research grants from NIH, which comes from OUR tax dollars. The pharmaceutical companies take our money and our donations but don’t give us a break on any of their new drugs. We should demand better.

If this was an allergy or acne treatment the ‘cost’ would be drastically reduced. Being that it’s seen as a possible ‘cure’ for cancer the drug companies greed gets the in the way of an affordable option.

I really do not understand why the costs are that high. Are Gilead and Novartis trying to regain all R and D costs in a short time period?

Long term treating an incurable disease is profitable. But curing a disease does not create a long term market for the

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