June 22, 2023 – CAR T-cell therapy is a comparatively recent and highly effective treatment for blood cancers comparable to leukemia. That is, when you can get it. For many, the drugs are too expensive to afford without insurance, and treatment requires access to the few hospitals that provide the therapy.
The barriers are particularly unequal because medications at the moment are “at the forefront” of successful treatment options, Dr. Sairah Ahmed, a lymphoma and myeloma specialist on the University of Texas MD Anderson Cancer Center.
CAR-T cells are described by the National Cancer Institute as a “living drug” during which T cells from a patient's own immune system are collected and reengineered in a laboratory to bind to and kill cancer cells. Large quantities of the cells are created after which infused back into the patient. The infusion process only takes an hour. Beforehand, the patient receives chemotherapy to weaken his immune system and prepare him for the uptake and proliferation of CAR-T cells.
Ahmed — who leads the CAR T-cell therapy program at MD Anderson — said each CAR A T-cell product can cost $500,000 out of pocket without insurance or Medicare. Other costs include what’s obligatory Chemotherapy, together with the burden of possible unwanted side effects.
However, there are programs that help. According to the MD Anderson websitePatients can avoid unnecessary bills by obtaining approval from their medical insurance provider before the exam. Additionally, for patients who’re U.S. residents and legal residents of Texas and who fall into the low-income or limited financial assets category, MD Anderson offers free care. In Fiscal year 2021MD Anderson provided $317.5 million toward this look after greater than 77,000 patients.
Only about 100 cancer facilities within the United States are equipped to offer treatment, making access and travel costs difficult for a lot of patients. A CAR-T therapy patient would must remain on the CAR-T cell center even after the cells have been infused.
“There may be resources available for certain groups to mitigate some of these costs,” Ahmed said. “But ultimately it’s the patient’s family who takes it in.”
“I think there are several socioeconomic barriers. And I think there are some centers that have the resources to help patients with some of those costs,” she said. “But certainly, even in the best resource-rich setting, we are not able to completely reduce that cost for a patient.”
In 2015, MD Anderson launched its first CAR T-cell therapy clinical trial and followed tons of of patients. The FDA approved CAR T-cell therapy for leukemia in 2017 with the primary product called Kymriah from pharmaceutical company Novartis. Since then, the FDA has approved five additional CAR-T therapies, all designed to treat blood cancers, from various types of leukemia to lymphoma to multiple myeloma.
CAR T-cell therapy nurse Jeremiah Bergeron said the success rate for patients achieving remission is 60%. Side effects, which could be serious, range from fever to neurological changes. In many cases, he said, the patient may suffer from cytokine release syndrome, when the engineered cells infused into the patient's body attack their very own cells, potentially causing fever, nausea, headaches, rash, palpitations, low blood pressure and discomfort Breathing.
“We do [take] conservative measures, but when it starts [cause] If you have difficulty breathing, we will give you oxygen. We’re going to give you medications to slow down CAR T,” Bergeron said.
“Exciting time”
First, a patient would must undergo two rounds of more traditional cancer therapy before being approved for CAR-T therapy. But within the last two years, Ahmed said, a patient who previously received just one treatment may consider treatment with CAR T-cell therapy.
“For patients whose disease has recurred within 12 months, CAR T-cell therapy is the preferred treatment choice and is a treatment with curative intent,” she said. Ongoing clinical trials using CAR-T therapy as a first-line treatment for big cell lymphoma have also expanded the variety of eligible patients.
Various aspects determine the unwanted side effects and negative reactions of patients using CAR-T therapy. According to Ahmed, this includes the patient's age and his or her state of health before therapy begins.
Sherry Adkins, a complicated practice nurse at MD Anderson, has developed an app called CARTOX that may assess the severity of a patient's unwanted side effects and link them to the perfect treatment.
Ahmed said doctors consider various aspects and make nuanced recommendations for patients based on their risks. “Perhaps finding ways to reduce toxicity is a way forward because it looks like the treatment is still very effective: it works well,” she said. “We just have to make it work without having so many side effects.”
“You want to have something right in front of your face and be able to quickly see what the symptoms are and then what you should do,” Ahmed said. “So this is really instrumental.”
She says there are several possible paths to refining CAR T cell therapy in the longer term, including research into targeting other antigens, using one patient's T cells to assist one other, and sequencing CAR T with chemotherapy or other treatments.
“I think there is still a lot of room for innovation and for next steps,” said Ahmed. “But you know, this is a really exciting time to be a cell therapy doctor right now.”