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 The new therapies, known as CAR T cells, are made by extracting
immune system T cells from an individual patient, altering their DNA
to sharpen their ability to spot and kill cancer cells, and infusing
them back into the same patient. In some early-stage clinical
trials, the treatments eliminated all trace of leukemia and lymphoma
in 40 percent to 90 percent of patients who had run out of other
options.
Industry analysts expect CAR T cell therapies will begin to reach
the market in 2017 and command prices of up to $450,000 if such
remarkable results are replicated in larger trials. The cost is for
a one-time application after which, if it works, signs of the cancer
are eliminated and the patient needs no more treatment.
"CAR T cell treatments are one of great advances in cancer therapy
in the last decade," said Dr. James Ferrara, head of hematological
cancer research at Mount Sinai Hospital in New York, who has not
personally tested them, but believes they could become the standard
of care among the estimated 10,000 U.S. patients who have exhausted
other treatment options. "In patients that have been unresponsive to
the most effective therapies we have, including bone marrow
transplants, leukemia seems to completely disappear."
But the production process takes about two weeks per patient,
representing a challenge to provide individualized medications for
large numbers of people. Wall Street expects Swiss-based Novartis,
which owns a New Jersey plant already producing CAR T cells for its
clinical trials, to seek approval next year for the first CAR T cell
therapy, months before its smaller rivals. Novartis bought the
facility in 2013 from Dendreon, whose Provenge treatment for
prostate cancer also required a personalized manufacturing process
but failed to take off, leading the company into bankruptcy.
"We feel confident we can scale up to thousands of patients a year
with a true global facility," said Usman Azam, Novartis' head of
cell and gene therapies. That would be enough to satisfy commercial
demand for at least a few years after the treatment is first
approved, he said, adding that a second plant could be built if
necessary. Azam said the company's treatment, called CTL019, is
"potentially curative."
Novartis plans to seek U.S. approval next year for CTL019 in
children with acute lymphoblastic leukemia (ALL) - a cancer caused
by uncontrolled proliferation of immature white blood cells that can
cause death within a year of its diagnosis. About 6,000 Americans
annually are diagnosed with ALL, about 60 percent of them under age
20.
In 2017, Novartis will aim for a far bigger market: patients with
the most common form of non-Hodgkins lymphoma, called diffuse large
B-cell lymphoma (DLBCL). An estimated 25,000 new U.S. cases of the
aggressive blood cancer, and 10,000 deaths from it, are seen each
year.
Kite and Juno in recent months have leased factories that they are
retooling. In the meantime, they are using contract manufacturers
for batches of their experimental cells now being used in clinical
trials, the companies said.
Kite is converting two leased plants. One facility, near its
headquarters in Santa Monica, California, will make CAR T cells used
in studies. A larger plant in El Segundo, California, will make
commercial supplies of KTE-C19, Kite's treatment for diffuse large
B-cell lymphoma, in time for a hoped-for launch in 2017 that would
put it neck and neck with Novartis.
David Chang, Kite's chief medical officer, expects to be able to
process enough CAR T cells for as many as 5,000 patients annually.
"That should cover the initial launch of KTE-C19 and maybe the first
two to three years afterward," Chang said. Kite will minimize
overhead and manufacturing costs by building individual modules that
can each handle a patient's cells and then "building out" with more
factory modules as demand increases, he added.
Juno plans early next year to begin operations at a plant it is
leasing in Bothell, Washington. It will seek approval for its
JCAR015 treatment for adult ALL by early 2017. The Seattle-based
company is testing other CAR T cells for pediatric ALL, non-Hodgkins
lymphoma and other cancers.
THE COST EQUATION
Novartis, by already making CAR T cells used in its clinical trials,
is better poised than Kite and Juno to move smoothly onto commercial
production, said Morningstar analyst Stefan Quenneville.
"A big pharmaceutical company like Novartis has the internal
resources to manage these types of things and a lot of experience
manufacturing different products and dealing with regulators,"
Quenneville said.
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Smaller Juno and Kite may be less able to control manufacturing
costs, and may need to charge even higher prices that would only be
justified if their treatments are exceptionally effective, said
Wedbush Securities analyst David Nierengarten.
"If their therapies cost $50,000 to $150,000 to make, clearly they'd
need to have a $250,000 to $450,000 price point," he said, but only
a potential cure could justify the higher range. Novartis may charge
between $200,000 and $300,000 for its treatment, Nierengarten said.
Drugmakers typically want an 85 percent profit margin for new
products and the same expectations will likely hold among companies
making CAR T cells, said James Kuo, a biotech analyst with Northland
Capital Markets.
Juno's treatment, under that formula, would likely be priced at
about $300,000 for its initial use in treating adult ALL and
generate annual sales of $250 million by 2020, if approved, Kuo
said. That would assume a $45,000 cost per patient of manufacturing
the cell therapy.
Juno Chief Executive Hans Bishop said the eventual price of JCAR015
will hinge mainly on how effective it is in larger trials. In an
earlier study among adults with aggressive ALL, 89 percent had
complete remissions. He said the company's factory should be running
within a year and supply "single digit" thousands of such patients
with JCAR015, if it is approved, exceeding the target U.S. adult ALL
population.
ANOTHER APPROACH
A second, unproven approach would be to use immune system cells
taken from healthy donors and modify them to serve many cancer
patients. Theoretically, oncology experts said, a single donor could
supply treatments for 4,000 patients. But to succeed and be safe,
those engineered cells would have to be further altered to ensure a
patient’s body accepts them. Otherwise, they may trigger a
potentially deadly immune system response against foreign invaders.
Many drugmakers consider the task all but impossible. But Novartis,
as well as France-based Cellectis in conjunction with Pfizer, are
working on such an “off-the-shelf” option they hope will be faster
and cheaper. Their CAR T cells could be frozen and shipped anywhere
in the world, for almost immediate use. And it stands to reason that
cells from a healthy donor could be hardier than T cells coming from
individual patients that have been battered by chemotherapy and
radiation, according to Cellectis Chief Executive Andre Choulika.
Using a new technology called gene editing, in which genes can be
switched off, Cellectis hopes to move into the more lucrative solid
tumor arena through its deal with Pfizer.
Leading CAR T cell companies have scoffed at Cellectis' approach.
But many are acquiring gene editing technology of their own that
will allow them to move in that direction, should Cellectis' efforts
work in its first human trials, planned in coming months.
"If it plays out, it would be a game-changer of a company," said
Behzad Aghazadeh, a managing partner at venBio, which holds
Cellectis shares. "Any reasonable person would say, 'I'll take the
off the shelf product.'"
But Chang, of Kite, predicted it could take another decade for
companies and researchers to safely perfect the technology and make
it available. "Biologically, I think the hurdle is extremely high."
(Reporting by Ransdell Pierson. Editing by Michele Gershberg and
John Pickering)
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