India Has Low-Cost CAR T-Cell Therapy: Can US Follow Suit?

 I'm Dr Maurie Markman, from City of Hope. I wanted to briefly discuss a very provocative news report. I normally don't talk about news reports. I try to focus on data in the peer-reviewed medical literature, but because this report was so provocative and it appeared in Nature, I thought it was worthy of highlighting as a matter of discussion.

This news in focus was published in Nature on March 28, 2024 entitled, "Cutting-Edge CAR-T Cancer Therapy Is Now Made in India – at One-Tenth the Cost." Let me repeat that: at one tenth the cost. 

This report is about a therapy that has been developed by a company in India. It's made in India, and it's been licensed in India. The effectiveness of this strategy, which is a chimeric antigen receptor (CAR) T-cell therapy strategy, was noted in the paper and in an abstract, which I read, at the American Society of Hematology meeting last year. 

There are some novel aspects of this, including the humanization of the approach, instead of in mice, reducing some of the potential side effects. Again, it's somewhat rather technical.

The bottom line is that the cost of this particular product, in US dollars, not Indian Rupee, was $30,000-$40,000 for this CAR T-cell product, in contrast to products in the United States that currently cost ten times this amount, if not more. 

Now, I cannot make any comment about the safety. I certainly cannot comment on the efficacy or relative efficacy. It is notable that these individuals, one of whom was quoted, who currently works at the National Cancer Institute, who is actually involved in the development, and others quoted in the article, who have noted that the number of patients treated is limited, but the data appear to be solid. 

The question is: Can we, in the United States, develop CAR T-cell products that are not 10% cheaper, not 20% cheaper but 50%, 60%, or 70% cheaper? Why? Clearly, the products we're talking about here have the potential to have an enormous impact on patient outcomes, survival, and cure. 

Certainly, CAR T cells are continually being examined in the solid-tumor space, as opposed to right now, where they're essentially exclusively in the hematologic malignancy space. We're talking about a vastly larger patient population that may benefit. 

A cost of $300,000-$600,000, which does not include the actual care you're providing patients, makes this essentially impossible to be used widespread in the solid tumors even if we come up with a strategy that works. 

If we're able to come up with an approach, whether it's from a regulatory or scientific way of doing this, without requiring certain expensive parts so that we can reduce the price by 70%, 80%, or 90% and do it safely and effectively, how many more patients may be able to benefit in the future? 

Again, what I'm quoting here is a news report. I'm not reporting definitive science, but it's highly provocative, and it's food for thought, hopefully for the near future. I thank you for your attention. 

https://www.medscape.com/viewarticle/india-has-low-cost-car-t-cell-therapy-can-us-follow-suit-2024a10009ps