4 ms·

An individually tailored cancer treatment is already available in the form of the CAR-T therapies, which might give an indication of how expensive it’ll be - yo

An individually tailored cancer treatment is already available in the form of the CAR-T therapies, which might give an indication of how expensive it’ll be - you were pretty much right on the dot, since each treatment in a course of treatments is estimated at $375,000.

iguy 6y ago
What is this money spent on? Is it a real cost per dose, or just a made-up number for something made in a research lab? Maybe another way to ask is: On the scale from 400k of white-shoe lawyer-hours, to 400k of custom 7nm silicon-etching, where should I mentally place this? The former isn't going to budge, the latter will cost pennies in a generation's time.
- seibelj 6y ago
  What they charge might be made up, but the costs of developing these drugs are astronomical. My wife is a cancer research scientist in immunotherapies and she can burn through tens of thousands of dollars in materials running a single experiment. And if she makes a mistake - the money is wasted!
  - iguy 6y ago
    For sure, I don't mean to suggest it's cheap research. But whether you charge a lot or nothing for the first few doses out of the lab, it seems like this won't really make a dent in the research cost. (I don't know if this $375,000 number is in that category, or not.)
  - xorfish 6y ago
    If the cost for every individual treatment is low, then the cost per treatment gets lower with more patients that can benefit from it.
- tbenst 6y ago
  Ha! The technology itself is cheap, fabricating a bunch of de novo mRNA is only a few hundred dollars these days. I’m not sure how much volume is needed for treatment, and there’s obviously much stricter QA/QC that must happen for human use, but still the actual manufacturing part is likely no more than single digit thousands per dose. At scale, per your semiconductor analogy, could likely be brought down to single-digit dollars with time.
rflrob 6y ago
There’s a lot of reason to suspect that, once the pipeline is set up and validated, tailored RNA will be a lot cheaper than CAR-T. cell culture is hard, whereas ordering a gene length DNA construct is “only” a few hundred bucks[1]. From there, getting it to mRNA is relatively straightforward. Doing this all medical grade and at scale will be a huge challenge, but should be significantly easier than mass producing CAR-Ts. [1] https://www.genewiz.com/Public/Services/Gene-Synthesis/TurboGENE https://www.genewiz.com/Public/Services/Gene-Synthesis/Turbo...
inglor_cz 6y ago
In order to produce a personalized anti-cancer RNA vaccine, you need to a) do a biopsy of the tumor and some healthy tissue, which is fairly cheap, b) do genetic analysis of those samples to find the differences. This used to be prohibitively expensive, but now is fairly cheap too, the price went down six (!) orders of magnitude since 2000, c) ask specialized software to find the optimal protein set to express. This software can be used for all the patients around, so cost of development will be split among them, d) synthetize the correct messenger RNA and embed it in lipid nanoparticles. Not cheap, but not prohibitively expensive either, this is basically a biological equivalent of a printing job, e) check the resulting drug and send it to the clinic where the patient is treated. This all together is a much more straightforward and automatized process than extracting tumor-invading lymphocytes from a patient and babying them in vitro with a lot of attention from human scientists and use of fairly expensive reagents. The price tag for this process per se should be at least two orders of magnitude lower. Then you must add the original development and testing costs, amortized equipment cost and profit. This is where the total price tag may balloon.
- sleepydog 6y ago
  If a parent and child develop the same cancer, is it any more likely that the same (mRNA) drug will work for both of them? Or do cancer cells mutate so much that they're unrecognizable between patients? It would have interesting implications if in the future a family could invest in a bank of mrna molecules for their future generations. A new form of wealth.
  - abiogenesis 6y ago
    I guess you should still perform steps (a), (b), and possibly (d) unless they develop it at the same time.
- Aeolun 6y ago
  If the total course of treatment is closer to $40000 or $4000 then it doesn’t seem unreasonable for insurance to cover it.

iguy 6y ago

What is this money spent on? Is it a real cost per dose, or just a made-up number for something made in a research lab? Maybe another way to ask is: On the scale from 400k of white-shoe lawyer-hours, to 400k of custom 7nm silicon-etching, where should I mentally place this? The former isn't going to budge, the latter will cost pennies in a generation's time.

seibelj 6y ago
What they charge might be made up, but the costs of developing these drugs are astronomical. My wife is a cancer research scientist in immunotherapies and she can burn through tens of thousands of dollars in materials running a single experiment. And if she makes a mistake - the money is wasted!
- iguy 6y ago
  For sure, I don't mean to suggest it's cheap research. But whether you charge a lot or nothing for the first few doses out of the lab, it seems like this won't really make a dent in the research cost. (I don't know if this $375,000 number is in that category, or not.)
- xorfish 6y ago
  If the cost for every individual treatment is low, then the cost per treatment gets lower with more patients that can benefit from it.
tbenst 6y ago
Ha! The technology itself is cheap, fabricating a bunch of de novo mRNA is only a few hundred dollars these days. I’m not sure how much volume is needed for treatment, and there’s obviously much stricter QA/QC that must happen for human use, but still the actual manufacturing part is likely no more than single digit thousands per dose. At scale, per your semiconductor analogy, could likely be brought down to single-digit dollars with time.

rflrob 6y ago

There’s a lot of reason to suspect that, once the pipeline is set up and validated, tailored RNA will be a lot cheaper than CAR-T. cell culture is hard, whereas ordering a gene length DNA construct is “only” a few hundred bucks[1]. From there, getting it to mRNA is relatively straightforward. Doing this all medical grade and at scale will be a huge challenge, but should be significantly easier than mass producing CAR-Ts. [1] https://www.genewiz.com/Public/Services/Gene-Synthesis/TurboGENE https://www.genewiz.com/Public/Services/Gene-Synthesis/Turbo...

inglor_cz 6y ago

In order to produce a personalized anti-cancer RNA vaccine, you need to a) do a biopsy of the tumor and some healthy tissue, which is fairly cheap, b) do genetic analysis of those samples to find the differences. This used to be prohibitively expensive, but now is fairly cheap too, the price went down six (!) orders of magnitude since 2000, c) ask specialized software to find the optimal protein set to express. This software can be used for all the patients around, so cost of development will be split among them, d) synthetize the correct messenger RNA and embed it in lipid nanoparticles. Not cheap, but not prohibitively expensive either, this is basically a biological equivalent of a printing job, e) check the resulting drug and send it to the clinic where the patient is treated. This all together is a much more straightforward and automatized process than extracting tumor-invading lymphocytes from a patient and babying them in vitro with a lot of attention from human scientists and use of fairly expensive reagents. The price tag for this process per se should be at least two orders of magnitude lower. Then you must add the original development and testing costs, amortized equipment cost and profit. This is where the total price tag may balloon.

sleepydog 6y ago
If a parent and child develop the same cancer, is it any more likely that the same (mRNA) drug will work for both of them? Or do cancer cells mutate so much that they're unrecognizable between patients? It would have interesting implications if in the future a family could invest in a bank of mrna molecules for their future generations. A new form of wealth.
- abiogenesis 6y ago
  I guess you should still perform steps (a), (b), and possibly (d) unless they develop it at the same time.
Aeolun 6y ago
If the total course of treatment is closer to $40000 or $4000 then it doesn’t seem unreasonable for insurance to cover it.