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MD and I work in the field. The technology is called CAR-T, as the article mentioned. It’s been used pretty widely for “liquid” tumors for a while (eg leukemia,
by dumbmrblah 4y ago
MD and I work in the field. The technology is called CAR-T, as the article mentioned. It’s been used pretty widely for “liquid” tumors for a while (eg leukemia, lymphoma, and multiple myeloma),but solid tumors are particularly difficult to target using current CAR-T therapy. If this CRISPR tech can be applied widespread to solid tumors that opens up a huge swath of patients that can be treated.
However cost and logistics are a huge factor. CAR-T therapy currently cost about $300,000-$500,000 to treat a patient. Beyond the cost of the immunotherapy you require a huge institutional investment because there are characteristic side effects that occur within the first 30 days of treatment which necessitates patients to be either admitted to the hospital for 30 days or stay in close proximity with daily check-ins (yes the cancer is getting treated BUT now your immune system is hyperactive which can be very dangerous in the short term).
Very few academic hospitals, let alone community hospitals, have this bandwidth which will lead to cancer care being concentrated in a handful of a few very large cancer specific institutions.
- jojobas 4y agoDoes that $300,000-$500,000 go mainly to super-highly qualified labour, expensive materials or rare machine time? Still more or less on par with a few rounds of chemo.
- dumbmrblah 4y agoGood question and I should have been more clear. The drug itself is $300,000-$500,000. It’s crazy expensive, but it’s not like a hedge fund patenting 100 year old insulin or something, it’s a bespoke medication. I still think they are price gouging however. The medical care would likely add another $500,000. https://ashpublications.org/ashclinicalnews/news/3469/CAR-T-Cell-Therapies-Predicted-to-Cost-More-Than-1 https://ashpublications.org/ashclinicalnews/news/3469/CAR-T-... All in about $1,000,000 per patient. There were some drama in England about NICE not willing to put the medication on NHS formulary because of the sheer expense. Is it better to treat 1000 diabetics or one cancer patient? https://www.biopharma-reporter.com/Article/2018/09/21/Novartis-disappointed-and-surprised-by-NICE-CAR-T-call https://www.biopharma-reporter.com/Article/2018/09/21/Novart... They ultimately approved it.
- MichaelZuo 4y agoWhat do you estimate is a fair price?
- newyankee 4y agoMy question would be more like, what would be needed for it to fall to 10% of its price ? Still only limited to developed world, but at least would make it more accessible
- jojobas 4y agoWell what makes the drug so expensive? Is it mostly mark-up for a high risk venture, is it actually taking 2+ man-years to formulate the drug for a particular patient, does it require already expensive components/reactants/whatever, bespoke machinery that would only produce a few doses in its lifetime, or some combination thereof?
- surfaceofthesun 4y agoNot responding with regard to any specific treatment, rather more generally. It’s a mixture of several things: * New/Niche Equipment * Few few commoditized inputs (e.g. lentiviral vector) * Labor Intensive * These setups look more like labs than large continuous or batch manufacturing sites * Everything requires GMP * This can mean weeks of training new personnel (even for well known manufactures) * Additional time & resources for FDA approval (safety testing, documentation, validation, This is a good reference: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5363291/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5363291/
- deleted 4y ago[deleted]
- ETH_start 4y agoWe need to massively scale back regulatory regimentation in medicine "FDA Deregulation Increases Safety and Innovation and Reduces Prices" https://marginalrevolution.com/marginalrevolution/2022/11/fda-deregulation-increases-safety-and-innovation-and-reduces-prices.html https://marginalrevolution.com/marginalrevolution/2022/11/fd... We will never get the pace of innovation and price reduction in medicine that we see in more market based product classes if we don't.
- aantix 4y agoIf money weren’t an issue, which institution/doctor would you send a loved one to if they needed such treatments?
- throwaway12245 4y agoYou'll want to sign them up for a clinical trial. Only CAR-T cell therapies that are FDA approved are for leukemias. [ and as a commentator points out, for lymphomas, I had always thought lymphomas were a subset of leukemia. mea culpa ]
- msla 4y agoI personally got CAR T-cell therapy (Yescarta) for Primary Mediastinal Large B-Cell Lymphoma: https://www.yescarta.com/ https://www.yescarta.com/ https://en.wikipedia.org/wiki/Axicabtagene_ciloleucel https://en.wikipedia.org/wiki/Axicabtagene_ciloleucel > On 1 April 2022, the FDA approved axicabtagene ciloleucel for adults with large B-cell lymphoma (LBCL) that is refractory to first-line chemoimmunotherapy or relapses within twelve months of first-line chemoimmunotherapy. I was in a clinical trial, though, but that was to determine the effectiveness of Anakinra in preventing serious side-effects; in my case, I only got a few mild fevers, which is the biochemical equivalent of winning the lottery, in a lottery where losers end up comatose and intubated. https://en.wikipedia.org/wiki/Anakinra https://en.wikipedia.org/wiki/Anakinra
- sergiotapia 4y agoI am very happy for your outcome, can't imagine the stress and fear you felt. So glad you had success, let's hope this becomes commonplace and people are saved from such a wretched fate.
- msla 4y agoI'm also very happy, especially since I was in complete remission as per a PET/CT scan a month after infusion after my cancer had survived two previous lines of chemotherapy (DA-EPOCH-R and R-GemOx) and had even shrunk but became more metabolically active after the second line. I'm still in complete remission, with further destruction of the tumor, six months after infusion, and there's some evidence the CAR T-cells can persist a decade after infusion: https://www.nature.com/articles/s41586-021-04390-6 https://www.nature.com/articles/s41586-021-04390-6
- deleted 4y ago[deleted]
- ThinkBeat 4y agoI sadly know little about all this technology. It is fantastically expensive at the moment from what you say. That keeps it away from the vast majority of cancer patients in the world. Technology does tend to get cheaper over time, though not always. Do you think this treatment could reach $30.000 in 2,5,10,15 years? And $300 in another 10,20,50 more years?
- solveit 4y ago> Technology does tend to get cheaper over time, though not always. What technology didn't get cheaper?
- LegitShady 4y agoti calculators
- TedDoesntTalk 4y agoHearing aids
- midoridensha 4y agoLike a lot of things, you need to add "in the US" to stuff like this, because outside the US these things are dirt cheap.
- yitchelle 4y agoSadly, physical calculators will soon be extinct as it will be replaced with calc app on the mobile phones.
- imiric 4y agoThe fact that hasn't happened after 15 years of smartphones suggests it won't happen at all. There's still a market for dedicated calculators. Schools don't allow students access to smartphones during tests, but calculators are fine.
- 120photo 4y agoDo you know if CAR-T or CRISPR technology goes into the brain?
- dumbmrblah 4y agoThere are clinical trials on Glioblastoma CAR-T treatment but it faces the same problems as any other solid tumor - namely the solid tumor microenvironment is not amenable to the current generation of CAR-T treatments In addition one of the dreaded side effects of CAR-T is neurotoxicity. CAR-T can cross the blood-brain barrier and leads to inflammation in the brain. You can treat it pretty quick with steroids but this side effect along with several other pro-inflammatory ones is the reason for the 30 day hospitalization sp treatment.
- 120photo 4y agoI seen what inflammation in the brain causes, not pretty.
- erisian 4y agoNot CAR-T or CRISPR AFAIK, but there's been some recent breakthroughs with getting treatments past the blood brain barrier, and promising glioblastoma treatments are in the pipeline as well. This is just what I've seen on the internet news, you'd find more than I know about it with some internet searches. I hope you aren't affected by GBM. If you are, or someone you know is, my only advice is to live life to the fullest while you can and don't let yourself fall into denial of the prognosis.
- 120photo 4y agoNot me but my wife. Will just put this out there for anyone else, the advancements made in Cancer treatment in the past few years are impressive. Don't lose hope. Also, listen to your doctors as all of the sudden everyone is oncologist. Listen to your doctors, seek second opinions, do research but question everything as there is a lot of snake oil for sale.
- ramraj07 4y agoAre you sure THIS treatment above is only 500k? It’s too bespoke and no way I can imagine it costing less than a few million per patient.
- dumbmrblah 4y agoI responded to another post similar down but you are correct. The drug is $500k, the surrounding medical care / hospitalizations etc pushes the total cost to over $1,000,000
- midoridensha 4y ago>The drug is $500k, the surrounding medical care / hospitalizations etc pushes the total cost to over $1,000,000 In the US. Outside the US, hospitalization isn't that expensive.
- zo1 4y agoFor reference, here in South Africa, it's about 250$ per day of hospitalization. Or 1500$ for ICU hospitalization per day. And we have private Healthcare here.
- deleted 4y ago[deleted]
- vagrantJin 4y agoPardon me. Is the 250$ per day in a public or private health facility?
- zo1 4y agoPrivate, though you don't pay it out of pocket for 95% of stuff as the medical aid covers it using your premium. Public is probably much much cheaper (free) but not a place any sane middle class person here would ever want to experience.
- 4y ago
- fnordpiglet 4y agoThis sounds like something that works out with time and scale. Thanks for the insight.
- bobmaxup 4y ago> which will lead to cancer care being concentrated in a handful of a few very large cancer specific institutions Wouldn't that be a good thing? Aren't specialized hospitals better at treating things that they specialize in?
- ugh123 4y agoFrom what OP said, I doubt they'd be able to keep up with the additional load of patient care (admittance especially) so there could be long wait times. At some point, capabilities like this mature on the science end but are slowed down on technology (scaled manufacturing). That would take significant investment by a big pharma or a new venture-backed investment to go after things like this. Fingers cross this happens within my lifetime. From the article: >“This is a tremendously complicated manufacturing process,” says Joseph Fraietta, who designs T-cell cancer therapies at the University of Pennsylvania in Philadelphia. In some cases, the entire procedure took more than a year.
- dumbmrblah 4y agoGood for people with money, resources to know where to get the best treatment and live close by; bad for everyone else. Disclaimer: I work at a giant cancer institution.
- daguava 4y agoIs that the real COST or the markup "cost"
- yosame 4y agoProbably both, they've got to make back the cost of developing and testing the therapy, but there's probably a profit markup on top of that.
- skissane 4y agoUS-based pharmaceutical companies maximise their margins in the US to make up for smaller margins in other markets. In many other countries, most prescription drugs are purchased by the government, which gives the government a lot of bargaining power which it uses to drive margins down. Prescription drug purchasing is much more disjointed in the US (negotiating with many private insurers instead of just the government), giving more bargaining power to the vendors and supporting higher margins.
- texasbigdata 4y agoThis doesn’t make sense. Consider two scenarios: company ABC sells only in the USA and Company XYZ is otherwise identical but also sells to Asia. You are implying that because XYZ has lower profit as a percentage yet higher profit as a nominal dollar amount, that XYZ will charge its American patients more. My intuition says both ABC and XYZ will charge Americans the same, namely the highest amount it possibly can under market/regulatory/PR/competitive considerations.
- throwtheacctawy 4y agoThe same that happens in medicine happens in college textbooks - and other forms of high margin, but relatively fixed/finite initial investment and stable cost to produce. American scholars write some of the most respected textbooks in the world, they are then sold in US colleges for $100-400/each. The same book is then sold in SE Asia and Africa for $10-40/each.
- derefr 4y ago> yes the cancer is getting treated BUT now your immune system is hyperactive which can be very dangerous in the short term Can immune-suppressive drugs be used during treatment?
- lll-o-lll 4y agoAhhh, personalised treatment for the mega rich. Soon our billionaire gods will be able to live far beyond a normal lifespan. I wonder how this will impact society?
- noduerme 4y agoIf it wrecks the rest of social media the way it's on its way to destroying Twitter, could be a long term good for everyone.
- quickthrower2 4y agoRich get a few years head start while effectively financing the making it cheaper part. Not “fair” but at the same time there is trickle down.
- dm319 4y agoThis isn't CAR-T, which is a chimeric antigen receptor (antibody) grafted onto a T cell. This is a T cell with an edited TCR receptor. This is quite different and comes under the 'adoptive TIL' category of treatments. It allows targeting of antigens not displayed on the cell surface. Every cell has to process their protein through a proteasome and present those peptides on the cell surface, which is where the advantage of this type of treatment comes in. In CAR-T we target a surface protein, and there's nothing to stop the cancer removing that protein from the cell surface.
- tauwauwau 4y agoHow do hospitals spend $10000 to $16000 a day?
- a99c43f2d565504 4y agoTo pay the people who make these things happen I suppose.
- polar 4y agoWhat is MD?
- deleted 4y ago[deleted]
- texasbigdata 4y agoMedical Doctor in the United States. Undergraduate (4 years) + Med School (3 years) + Residence (1 to 3 years), roughly.
- marstall 4y agoFor comparison on the cost question: I received conventional, pre-CAR-T treatment for ALL Leukemia about 9 years ago. That consisted of chemo, total body irradiation and a successful bone marrow transplant. Cost was $300,000.
- queuebert 4y agoAll of you AI people reading this should work on predicting side effects and outcomes from these therapies. That would help decrease the cost tremendously.
- UltraViolence 4y agoAnd the first sequencing of the human genome took 10 years and cost hundreds of millions of dollars. Today you can do it for $100 in a couple of hours. The same will happen with CAR-T and CRISPR.