[Mark]

Forbes article on immunotherapy / cancer treatments

by Mark on Wed May 07, 2014 8:09 pm

Interesting article in Forbes regarding potential future therapies. Being a Forbes article, there is a business slant to it. It raises some different issues regarding costs of the therapies and the rising costs of drugs/healthcare. No mention of myeloma, but these are issues that will effect us in the future.

Despite the historic promise presented by the treatment, Jimenez says, the biggest hurdle facing efforts to develop new cancer cures might be economics, not science. “What you know is not going to happen is the ability to stack therapies on top of each other at the current price and expect people to pay,” he says. “ The whole oncology pricing structure needs to be rethought because it’s reached the level that is not going to be sustainable for the long term. ”

This is actually what’s driving his strategy of bulking up his cancer division–so it can compete–and at the same time betting on the wildest technology. He expects “a new brutal world” for health care companies as countries around the world are forced to double health care spending because of age and illness over the next ten years. Paradoxically, the rapid increase in costs will lead governments to try to cut costs, making competition between hospitals, doctors and drug companies tougher.

“You’re going to see these companies that are going to get crushed by this new environment, despite the fact that health care spending is going to almost double,” Jimenez says. He has a team actively exploring new ways of pricing cancer drugs, in which several medicines are sold for the price of one, or health systems or insurers pay based on how many patients are cured.

When researchers talk about CARTs they often reference the cost of a bone marrow transplant–$350,000 for a single course of treatment. Why not? There are biotech drugs for rare diseases that cost $400,000 or more a year. But Jimenez says that would be too much–that even for a breakthrough the cost needs to be lower.

http://www.forbes.com/sites/matthewherper/2014/05/07/is-this-how-well-cure-cancer/

[Mark]

Re: Forbes article on immunotherapy / cancer treatments

by Mark on Sun Jun 29, 2014 10:32 am

Here is a recent Journal article from the doctors at UPenn who are associated with CAR-T cells. It is a little technical but the sections related to the toxicities and where they could potentially be placed into treatment plans could be interesting to some of you.

"Some degree of persistent engraftment is also required, although the length of this persistence has not been established. We hypothesize that for CAR T cells to be able to replace allogeneic transplantation as definitive therapy, persistence for at least several months will probably be required based on the kinetics of tumor clearance that we have observed.37 If, on the other hand, CAR T cells are only to serve as a bridge to follow on therapy with allogeneic transplant, then they may only need to persist for a few weeks until conditioning for the transplant begins. The question of whether CAR T cells are on par with the efficacy of transplant would best be answered in randomized trials. However, short of this, we also anticipate many recipients of CAR T cells will not eligible for transplant or have comorbidities or only suboptimal donors available such that the transplant is impractical. Long-term follow up of these patients will provide critical information about the durability of CAR T-cell–induced remissions. Alternatively, the answer may come from patients who have relapsed after an allogeneic transplant, for whom a second transplant may not be possible or efficacious; these patients may benefit from CAR T-cell products that potentially offer durable remissions. The use of CAR-modified donor T cells to treat relapsed ALL is being tested by our group and will hopefully be studied in a multisite trial. In addition, multisite trials are underway in collaboration with Novartis, and a dual-center grant-funded trial between MSKCC and the University of Pennsylvania involves a competitive repopulation study design where T cells transduced with Penn vector and MSKCC vector are infused simultaneously into each patient."

"Because gene-modified T cells are emerging as powerful therapies capable of effecting dramatic antitumor responses as well as significant toxicities,50 strategies to incorporate suicide genes or abortive mechanisms may become necessary. This is especially true as CAR-directed T cells are further engineered to express cytokines and adjuvants51,52 that could act in trans to amplify inflammatory cascades, or as CAR T cells directed to antigens with more widespread expression are tested. However, suicide systems are still difficult to implement in all CAR T-cell trials, because many of the suicide systems are immunogenic (eg, herpes simplex virus thymidine kinase) or require intravenous administration of the suicide-inducing prodrug.53 Alternatively, altering the homing of T cells via enforced expression of chemokine receptors54 or pharmacologic blockade of chemokine receptors55 may be a strategy to both enhance efficacy and alleviate toxicity."

http://bloodjournal.hematologylibrary.org/content/123/17/2625.full?sso-checked=1

Mark

[Beacon Staff]

Re: Forbes article on immunotherapy / cancer treatments

by Beacon Staff on Mon Jun 30, 2014 5:37 am

For those interested in reading more on CAR-T, this recent forum thread has some useful references (including links to Beacon news articles that were published when the technology was first being announced and explained in the press):

"Pfizer bets on Cellectis (and CAR-T)"

There is a Forbes article included in the above posting that includes a link back to the Forbes article mentioned in the original posting in this thread.

[ivanm]

Re: Forbes article on immunotherapy / cancer treatments

by ivanm on Mon Jun 30, 2014 10:50 am

I don't buy much the following from the article - "the biggest hurdle facing efforts to develop new cancer cures might be economics, not science."

Let me say this. I had an opportunity to work on the deal aspect of an early stage immunotherapy myeloma drug. I am not a finance guy, but to my layman mind, the numbers looked astounding. Myeloma will probably be about a $15-20 billion market in the next few years. This is a very, very lucrative market with some significant money making opportunities. That said, it is high risk.

I guess what I am saying is that the money is there. However, considering that it is more and more competitive and there are too many people that want a slice of this $15-20b pie, some companies will get slaughtered. Regardless, the increased competition should not impede development but may reduce profits and shake out the less effective drugs.

But there is still too much money to be made in this field to say that money will impede development. Where there is money to be made there are investors. The $15M in development cost to take a drug to stage II before big pharma comes in is nothing in the grand scheme of things.

So don’t fret fellow patients. Money is not going to be the main impediment for a cure. At least that’s my view and my 2c.