{"id":13673,"date":"2019-01-16T12:00:04","date_gmt":"2019-01-16T17:00:04","guid":{"rendered":"http:\/\/lifeinsurance-orleans.ca\/Life-Insurance-Blog\/car-t-cell-therapy\/"},"modified":"2019-04-30T21:32:57","modified_gmt":"2019-05-01T01:32:57","slug":"car-t-cell-therapy-is-a-ground-breaking-cancer-treatment-and-its-expensive-and-difficult-to-deliver-is-canada-ready-for-it","status":"publish","type":"post","link":"https:\/\/blog.lifeinsurance-orleans.ca\/index.php\/2019\/01\/16\/car-t-cell-therapy-is-a-ground-breaking-cancer-treatment-and-its-expensive-and-difficult-to-deliver-is-canada-ready-for-it\/","title":{"rendered":"CAR T-cell therapy is a ground-breaking cancer treatment\u2014and it\u2019s expensive and difficult to deliver. Is Canada ready for it?"},"content":{"rendered":"
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By the time Cameron Lahti sat down to receive CAR T-cell therapy, he\u2019d been through six-and-a-half years of chemotherapy. \u201cFor him, it was an average day,\u201d says his mother, Debbie Dean-Lahti.<\/strong> \u201cHe played video games or watched a movie. It wasn\u2019t intrusive at all.\u201d Cameron already had a Hickman line\u2014a central venous catheter often used to administer chemotherapy\u2014so there wasn\u2019t even a needle involved. Instead, a syringe was attached to the line and in went the T-cells. \u201cIt was just a simple push,\u201d says Debbie.<\/p>\n

But that day was far from average for Cameron. Because that was the first day of his longest chemo-free remission to date: two-and-a-half years and counting. After being diagnosed with B-cell acute lymphoblastic leukemia in 2010 at age three, Cameron spent three-and-a-half years in chemotherapy. He relapsed six months after completing treatment, and started a second round of chemotherapy in 2014. Two years later, he relapsed again, while still in chemotherapy. Typically the next line of treatment would be a bone marrow transplant, but the family had another option, a new genetic treatment called CAR T-cell therapy. With support from the Hospital for Sick Children, they travelled to Philadelphia where Cameron took part in a clinical trial, the only way to receive CAR T-cells at the time.<\/p>\n

It looks like that\u2019s about to change. In September, Health Canada authorized the commercial use of a CAR T product called tisagenlecleucel (trade name Kymriah) for adults with relapsed or refractory diffuse large B-cell lymphoma and for children and young adults (ages three to 25) with relapsed or refractory ALL. On Tuesday, the Canadian Agency for Drugs and Technology in Health, which conducted a health technology assessment of tisagenlecleucel, recommended<\/a> that it be funded for Canadian patients so long as the price is lowered and certain conditions around implementation are met\u2014as groundbreaking as CAR T-cell therapy is, it\u2019s also incredibly complex and expensive to deliver. And in many ways, it has yet to be proven.<\/p>\n

What is CAR T-cell therapy?<\/strong><\/h2>\n

CAR T-cell therapy is a \u201cprecision medicine\u201d treatment, meaning treatment that is tailored to individual patients. It also belongs to a new group of cancer treatments known as immunotherapy. In CAR T, a person\u2019s T-cells\u2014which are among the body\u2019s most important immune cells\u2014are taken from their blood, and then infused into the person\u2019s bloodstream. CAR stands for \u201cchimeric antigen receptor,\u201d which is the extra genetic matter added to the T-cells. CARs allow T-cells to detect and kill cancer-carrying cells, which can otherwise be difficult to identify. Once in the bloodstream, CAR T-cells continue to multiply, and this is why the treatment is sometimes referred to as a \u201cliving drug.\u201d<\/p>\n

Why is there so much excitement about it?<\/strong><\/h2>\n

CAR T-cell therapy has shown some very promising results in the treatment of blood cancers. In one tisagenlecleucel trial<\/a>, 82 percent of the 79 children with ALL who received the treatment were in remission three months after the infusion; at 18 months, the overall survival rate was 70 percent. In another<\/a>, 40 percent of 93 adults with diffuse, large B-cell lymphoma showed a \u201ccomplete response\u201d a year after the treatment. Both trials were single-arm and both were supported by Novartis, the Swiss-based pharmaceutical company that manufactures and has the patent for Kymriah.<\/p>\n

But what is most exciting about these results is that the patients who participated in these studies were unresponsive to or had relapsed multiple times after receiving chemotherapy and\/or bone marrow transplant. \u201cCAR Ts have opened up a new treatment option for us for kids who are otherwise untreatable,\u201d says Donna Wall, pediatric hematologist and section head of the bone and marrow transplant program at Sick Kids Hospital. \u201cWe\u2019re definitely seeing kids\u2014and we always hesitate using the cure word\u2014who we had absolutely no other options for.\u201d<\/p>\n

As promising as CAR T-cell therapy is, it comes with many complications. The wait time between extraction and infusion can be two to four months, or even longer, says Wall. During that time, a patient\u2019s treatment goes into what she calls a \u201cholding pattern.\u201d They need to be given \u201cjust enough and not too much\u201d chemotherapy. \u201cFor me, [this] is one of the harder parts of treatment,\u201d says Wall. \u201cIf you think of it, these kids all have really bad leukemia. And they\u2019ve already failed many lines of treatment. It\u2019s often very hard to keep them in some level of disease control.\u201d<\/p>\n

There can also be difficulties with manufacturing. \u201cAbout 20 percent of the kids who we start to try to make CAR Ts for, we\u2019re not able,\u201d says Wall. \u201cThe number of T-cells that a patient has in their circulation that we can collect, and the use and the function of those cells, is something that we can\u2019t control,\u201d she explains.<\/p>\n

And then there are the side effects. Almost a third of the patients Wall sees will have a very serious complication called cytokine release syndrome, in which what is sometimes called a \u201cstorm\u201d of cytokine proteins flood into the bloodstream as a result of T-cells at work. \u201cBasically the T-cells are doing too good a job,\u201d says Wall. While CRS can be a sign that the CAR therapy is working, it can lead to severe problems with blood pressure, fever, organ function, and possible brain inflammation. It is usually treatable and typically short-lived, but requires immediate attention. Patients must be closely monitored for at least a month after infusion, and many are admitted to hospital for this monitoring period.<\/p>\n

CAR T-cell therapy is known as a \u201cone-time treatment\u201d\u2014once the cells are in your body, they\u2019re there to stay. But some patients receive a second infusion, as Cameron Lahti did, when it was discovered, six months after the first infusion, that he had some \u201cbaby B-cells\u201d in his system. People who receive CAR T have their B-cells checked regularly and can expect to receive a weekly or monthly infusion of immune globulin for the rest of their lives. \u201cAs long as the CAR Ts are working, the [patient] will not make IG, and so we have to give that replacement,\u201d says Wall.<\/p>\n

In addition to these treatment complexities, there are a number of logistical challenges that come with administering tisagenlecleucel. For example, cost. Tisagenlecleucel is priced at $475,000 in the U.S., and \u00a3282,000 in the U.K. The price submitted to CADTH for Canada by Novartis is confidential. But as Harindra Wijeysundera, vice-president of medical devices and clinical interventions at CADTH, told the Globe and Mail<\/em><\/a> in December, the drug\u2019s price is only part of the cost of delivering the treatment. Other expenses include pre- and post-infusion monitoring\u2014which to date have typically been inpatient\u2014and also transportation and accommodation for patients to the centres authorized by Novartis to provide the treatment. Currently only five provinces in Canada have such facilities.<\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

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CAR T-cell therapy: It’s ground-breaking, expensive, and complicated to deliver. Is Canada ready for it to be introduced commercially?<\/p>\n

The post CAR T-cell therapy is a ground-breaking cancer treatment—and it’s expensive and difficult to deliver. Is Canada ready for it?<\/a> appeared first on Healthy Debate<\/a>.<\/p>\n<\/div>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[],"tags":[],"jetpack_featured_media_url":"","_links":{"self":[{"href":"https:\/\/blog.lifeinsurance-orleans.ca\/index.php\/wp-json\/wp\/v2\/posts\/13673"}],"collection":[{"href":"https:\/\/blog.lifeinsurance-orleans.ca\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blog.lifeinsurance-orleans.ca\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blog.lifeinsurance-orleans.ca\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/blog.lifeinsurance-orleans.ca\/index.php\/wp-json\/wp\/v2\/comments?post=13673"}],"version-history":[{"count":4,"href":"https:\/\/blog.lifeinsurance-orleans.ca\/index.php\/wp-json\/wp\/v2\/posts\/13673\/revisions"}],"predecessor-version":[{"id":14730,"href":"https:\/\/blog.lifeinsurance-orleans.ca\/index.php\/wp-json\/wp\/v2\/posts\/13673\/revisions\/14730"}],"wp:attachment":[{"href":"https:\/\/blog.lifeinsurance-orleans.ca\/index.php\/wp-json\/wp\/v2\/media?parent=13673"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blog.lifeinsurance-orleans.ca\/index.php\/wp-json\/wp\/v2\/categories?post=13673"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blog.lifeinsurance-orleans.ca\/index.php\/wp-json\/wp\/v2\/tags?post=13673"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}