In a decade, CAR-T cell treatment might be the first step for many cancer patients

Around this time last year, the staff at Irish Medical Times were getting ready to host the Irish Healthcare Awards, and, in particular, preparing to give an award to Prof Larry Bacon (representing a wider team of doctors and healthcare staff at St Jamess Hospital) for conducting the first Irish cell treatment for lymphoma, the first time that a Chimeric Antigen Receptor T-Cell (CAR-T) had been used in Ireland.

Previous to this, any patient who could benefit from this personalised therapy had to travel to the UK to receive the treatment. The job of preparing a patient for this treatment is a complex one involving collecting the patients own T cells, which were then prepared for transport to the UK in the hospitals on-site stem cell laboratory.

When these cells were sent overseas and re-engineered to target cancer cells, they were then sent back to St Jamess stem cell lab for qualification, before they were re-infused into the patient. The patient would receive three days of lymphodepleting chemotherapy before infusion. It was a serious operation, and a cause for celebration that we could do this kind of complex work here.

This CAR-T therapy which uses modified cells from a persons own body to fight cancer, is potentially life-saving for some patients diagnosed with certain types of blood cancers lymphoma, leukaemia and myeloma.

Emerging research also suggests that such therapies could have the potential to treat other types of cancers in the future including some solid tumours, and that could change the paradigm in cancer treatment in Ireland. It would be a huge shift in how we treat cancer, and the potential for improved treatment and cure rates is obvious.

This whole area of advanced therapy medicinal products (ATMPs) is a hugely exciting and promising area in the world of medicine. These medicines based on tissue, genes or cells have the potential to provide ground-breaking opportunities for treating disease and injury.

Its exciting, but we cant say exactly how this might change things. Using your own T cells to fight cancer might surpass current methods by a good margin. Or not. Certainly, were not going to stop with the current technology its simply going to get better.

In a decade, CAR-T cell treatment might be the first step for many cancer patients. We dont know. Or, at least, this was what we presumed that CAR-T therapy was here, was working, and was here to stay.

However, a new report on the progress of CAR-T therapy in Irelandhas pointed out that in Ireland, it is likely that it will be too expensive to provide these therapies at a significant scale under the current commercial routes through which they are available.

The current health and manufacturing systems are also likely not adequately equipped, resourced or structured currently to develop or deliver CAR-T or other cancer immunotherapies alongside existing health services at the larger scale that could potentially benefit patients in the future here.

This poses a fundamental and existential problem for the Irish health service and the HSE. Science is pointless without application; there is no point in being able to do CAR-T cell therapy and not being able to do CAR-T cell therapy (because you dont have the money). If we dont have the money to implement a system so that it saves lives, what, after all, was the point of all the research?

The report, which was developed by a team of researchers in Maynooth University in collaboration with Breakthrough Cancer Research, calls on the Government and the National Cancer Control Programme (NCCP) to urgently consider and develop a national strategy for Ireland around the provision of cellular therapies, including CAR-T therapies.

It is vital that such a strategy would consider how to achieve more sustainable mechanisms to develop, and deliver, new and available treatments to patients, at a cost that is more affordable to the national public health system.

The report outlines ten policy recommendations which seek to recognise and address patients current needs and sets out key components that need to be considered under such a national strategy.

I wont bore you with a list of the recommendations, except to point out that politically, the easiest thing to do here is to do what we always do ignore this problem while it is still a relatively small one that affects very few people.

But since the technology is always moving, and we would reasonably expect a lot more people to become suitable candidates for CAR-T therapy, it makes sense now to plan to be able to afford the treatment for everybody.

Obviously, ATMPs offer huge hope for the future treatment of cancers, and the fear would be that in anticipation of that cost, the Irish government stalls and delays in its bureaucratic manner kicking the can of medicine down the road until some later time when we can afford it.

That would be a huge mistake, a fatal error. A negation of our will to control our destiny. We can and we should invest in this technology and reduce cancer deaths just cause. Just because we can and because it is a just cause. We can save people and we can show others how to do it. We should welcome this challenge, invest in it, and demonstrate the point of economic success. And we should lead, where possible certainly in the area of investment.

We need to move in the direction of the light. There are problems to be solved relating to cost, but these problems will come anyway. Investing now will save money later, because, lets face it, were not going to let people die if we have their actual cure.

We would and have shown we are capable of letting people die if we dont get to them on time. And often the bureaucratic behemoth seems to move very slowly. Almost deliberately slowly.

We need to move quickly and enthusiastically on this. Its an opportunity to do great good for science and medicine in this country. And save lives. As Mathew Perry would have said: Could there be more noble goals?

The question for us now is whether we want to embrace the future of medical innovation and technology, or whether we want to remain the country with the health service that has the best excuses in the world for failure.

The time has come to be know for something else, something that is a powerful force in medicine strategic forward planning to improve services of the future. Services not even imagined yet.

We could do that by embracing and pushing ATMPs because their role in medicine is only going to grow.

See more here:
A national strategy for CAR-T therapies urgently needed - Irish Medical Times