CAR T-Cell Therapy: A Promising but Costly Treatment for Blood Cancers
CAR T-cell therapy is a relatively new and highly effective treatment for blood cancers such as leukemia. It is a type of immunotherapy that uses a patient’s own immune system T cells, which are collected and reengineered in a lab to bind to cancer cells and kill them. The infusion process takes only an hour, but prior to that, the patient receives chemotherapy to weaken their immune system to prepare for the intake and proliferation of CAR T cells. While the treatment has shown great promise, it is also expensive and not widely available.
The Cost of CAR T-Cell Therapy
Each CAR T-cell product can cost $500,000 out of pocket without insurance or Medicare. Other costs include the necessary chemotherapy, along with the burden of potential side effects. For many patients, the drugs are too expensive to afford without insurance coverage, and treatment requires access to the few hospitals that offer the therapy. Only around 100 cancer facilities in the United States are equipped to use the treatment, making access and travel costs challenging for many patients.
Barriers to Access
Barriers are especially unequal because the drugs are now in “the frontline setting” of successful treatment options, said Sairah Ahmed, MD, a specialist in lymphoma and myeloma at the MD Anderson Cancer Center at the University of Texas. There are programs to help, though. According to the MD Anderson website, patients can avoid unnecessary bills through authorization from their insurance company before getting a scan. In addition, for patients who are U.S. citizens and legal residents of Texas, and who fit into the low-income or limited financial assets category, MD Anderson provides uncompensated care. In fiscal year 2021, MD Anderson provided $317.5 million in such care for more than 77,000 patients.
The Success Rate and Side Effects
Jeremiah Bergeron, a CAR T-cell therapy nurse, said the success rate for patients achieving remission is 60%. The side effects, which can be severe, range from fever to neurological changes. In many cases, the patient can have cytokine release syndrome, when the reengineered cells infused into the patient’s body attack their own cells, potentially causing fever, nausea, headaches, a rash, a rapid heartbeat, low blood pressure, and trouble breathing. “We do [take] conservative measures, but if it starts to [cause] shortness of breath, we will put you on oxygen. We will give you medication so that it can be used to slow down CAR T,” Bergeron said.
Potential Avenues for Refining CAR T-Cell Therapy
Ahmed said there are several potential avenues for refining CAR T-cell therapy in the future, including research on targeting other antigens, using one patient’s T cells to help another, and sequencing CAR T with chemotherapy or other treatments. “I think there’s still a lot of room for innovation and for kind of next steps,” Ahmed said. “But you know, this is a really exciting time to be a cellular therapy doctor right now.”
Innovation and Next Steps
Initially, a patient would have to go through two rounds of more traditional cancer therapy before being approved for CAR T therapy. But in the last 2 years, Ahmed said, a patient who has only had one previous treatment can consider CAR T-cell therapy treatment. For patients who have disease that relapsed within 12 months, CAR T-cell therapy is the preferred choice of treatment, and it is a curative intent treatment. Ongoing clinical trials using CAR T therapy as the first treatment for large-cell lymphoma have also widened the populations of eligible patients.
Various things determine the side effects and negative reactions of patients using CAR T therapy. Ahmed said those include the patient’s age and their health before getting the therapy. MD Anderson advanced practice nurse Sherry Adkins created an app called CARTOX that works to grade how severe a patient’s side effects are and link that to the best treatment. Ahmed said doctors look at various factors and make nuanced recommendations for patients based on their risks. “So potentially finding ways to decrease toxicity is a way forward because it looks like the treatment is still really efficacious: It works well,” she said. “We just have to kind of make it work without having so many side effects.”
CAR T-cell therapy is a promising treatment for blood cancers, but it is also expensive and not widely available. Patients who can afford the treatment and have access to hospitals that offer it have a 60% chance of achieving remission. However, the side effects can be severe, and patients need to be carefully monitored during and after treatment. Researchers are working on refining CAR T-cell therapy to make it more effective and less toxic. Despite the challenges, many doctors and patients are optimistic about the future of this innovative treatment.