CAR-T therapy is a groundbreaking form of immunotherapy that has revolutionized the treatment of certain types of cancer.
It involves genetically modifying a patient’s own T-cells to recognize and attack cancer cells in the body. Since 2017, the Food & Drug Administration (FDA) has approved six CAR-T therapies. These therapies have been approved for the treatment of blood cancers, such as lymphomas, certain types of leukemia, and most recently, multiple myeloma.1
Process
The process of CAR-T therapy begins with the collection of a patient’s T-cells through a process called leukapheresis. These T-cells are then sent to a laboratory where they are genetically engineered to express a chimeric antigen receptor (CAR) on their surface, which will recognize a specific antigen present on the surface of cancer cells. The cells are then grown and multiplied in the lab in a process that can take several weeks to produce the large number of CAR-T cells needed.2
Once collected, these cells are then infused back into the patient, where they can recognize and target cancer cells that express the antigen recognized by the CAR. The CAR-T cells undergo a rapid expansion in the patient’s body, leading to a sustained anti-cancer immune response.
Side Effects
Despite their success, CAR-T therapies are associated with unique challenges and potential side effects. The activation of CAR-T cells can lead to a phenomenon called cytokine release syndrome (CRS), which is characterized by the release of inflammatory cytokines and can cause flu-like symptoms, fever, and in severe cases, organ dysfunction. Another potential side effect is neurotoxicity, which can manifest as confusion, seizures, and other neurological symptoms.
To manage these side effects, specialized medical teams closely monitor patients receiving CAR-T therapy and provide supportive care, including the administration of immunosuppressive drugs and other interventions. Ongoing research is focused on improving the safety and efficacy of CAR-T therapies, including the development of next-generation CAR designs and combination therapies.
Costs and Outcomes
Prior to the development of CAR-T therapy, the standard treatment for these types of cancers was a stem cell transplant (SCT) with a corresponding inpatient hospital stay associated with both pharmacy and medical costs. Due to the nature of CAR-T therapy, inpatient hospital stays are also required to administer the drug and to monitor the patient for side effects and efficacy, however, according to one study, the mean length of stay was between 3-10 days shorter while receiving CAR-T as compared to those undergoing a SCT.3 These lower non-pharmacy charges were tempered by higher upfront pharmacy charges associated with CAR-T therapy, where charges could be as high as $450,000.3 This study found slightly higher overall costs for CAR-T therapy, but also found benefits which included shorter ICU stays and lower ICU admission rates.3
CAR-T therapy has shown remarkable efficacy in clinical trials, with high response rates and durable remissions observed in patients with relapsed or refractory hematological malignancies. Ongoing research is exploring CAR-T’s potential for treatment of other types of cancer.
Sources:
- “CAR T Cells: Engineering Patients’ Immune Cells to Treat Their Cancers,” National Cancer Institute, accessed December 11, 2023, https://www.cancer.gov/about-cancer/treatment/research/car-t-cells.
- “Car T cell Therapy and Its Side Effects,” American Cancer Society, accessed December 11, 2023, https://www.cancer.org/cancer/managing-cancer/treatment-types/immunotherapy/car-t-cell1.html.
- “CAR T-Cell Therapy Leads to Shorter Hospital Stays, Lower Nonpharmacy Costs Despite High Overall Cost,” OneLive, accessed December 11, 2023, https://www.onclive.com/view/car-t-cell-therapy-leads-to-shorter-hospital-stays-lower-nonpharmacy-costs-despite-high-overall-cost.
