- CAR-T therapy can cure terminally ill cancer patients but it is prohibitively expensive, costing hundreds of thousands of dollars.
- Leveraging recent advances in chip technology scientists can create and mass produce small machines to re-engineer the immune system.
- But the scientific community needs public-private partnerships to ensure this medical breakthrough becomes accessible to everyone.
After suffering 16 months of chemotherapy for her leukaemia, treatment options for six-year-old Emily Whitehead had run out. Her parents began to fear the worst. As a last-ditch effort, the University of Pennsylvania enrolled Emily in a clinical trial that involved reprogramming her immune cells to destroy her cancer. The results were phenomenal. Emily not only survived, but nine years later she is a healthy teenager with no cancer.
Behind Emily’s recovery is CAR-T (Chimeric Antigen Receptor T cells ) a cell-based therapy that has become a revolutionary weapon in the treatment of previously incurable blood cancers.
CAR-T cell therapy genetically modifies a patient’s immune cells to hunt and kill cancer cells. It is a form of personalized immunotherapy that can provide lasting remissions, even to terminally ill patients who have just months to live and for whom classic treatment options have not worked.
More than 400 clinical trials of CAR-T therapies are currently in progress. Their impact could be enormous. According to the World Health Organization, cancer causes one in six deaths worldwide. Personalized cell therapy has the potential to save millions of lives. Preliminary data even suggests that engineering immune cells may one day be used to treat heart failure, autoimmune diseases, diabetes and HIV.
Why does CAR-T cost so much?
But unit economics are hobbling the rollout of CAR-T to the full number of patients whose lives it could save. The treatment alone can cost up to $475,000 and US hospitals can charge as much as $1.5 million to administer it, once ancillary costs are taken into account.
So why this high price? With conventional therapies, drug makers get economies of scale: the more they produce, the cheaper each dose becomes.
But CAR-T is tailor-made for each patient, and behind every treatment lies a highly sophisticated process, which is time-consuming and brutally expensive.
The patient’s immune cells are collected, purified in various steps, genetically modified, formulated at the right dose and reinfused. This complex manufacturing process requires shipments to different labs and frequent manual interventions, which introduce the risk of human error and potentially life-threatening side effects. Compounded by the fact that CAR-T consists of living cells that vary in potency, manufacturers need to continuously test results throughout the process.
The result is a production time that can take weeks, and an unaffordable price. Unless these economics change, this treatment will not reach patients whose lives it could save – it will only reach those privileged enough to afford it.
Technology holds the key to reducing costs
There is, however, hope. The most recent insights in nanotechnology, artificial intelligence (AI), biosensors, and the Internet of Things could help overcome the current roadblocks in making personalized cell therapies affordable.
The solution to democratize these therapies lies in automating their manufacturing process, which would reduce the cost, time, and risks significantly. This will require several engineering breakthroughs but is technically possible.
Recent advances in chip technology provide inspiration. The modern world’s insatiable demand for better computers, gaming consoles, and smartphones has resulted in the extreme miniaturization of transistors – the components which drive technology’s processing capacity – as more transistors on smaller circuits enables new and stronger technological abilities…..
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