Cancer: "I See Patients Who Thought They Were Already Dead And Suddenly, They Are Cured", Says Father Of A Revolutionary Treatment – Nation…

Madrid.- Immunologist Carl Jun has started a revolution in medicine. He speaks of the resurrection himself like Lazarus, the man who died and was miraculously resurrected by Jesus Christ in the biblical account. June, born 69 years ago in Denver (United States), is the father of CAR-T treatment, a powerful strategy that includes Drawing blood from cancer patients, capturing their white blood cells, and re-engineering them in the laboratory to multiply their ability to kill cancer cells., Complete remission of blood tumorsleukaemia, lymphoma, and myelomaalready number in the hundreds.

The researcher remembers his first case, Bill Ludwig, a 65-year-old prison guard who died of leukemia in August 2010. He was a Catholic and he supported him immensely, recalls June, director of the Center for Cellular Immunotherapy at the University of Pennsylvania. The patient had a tumor of about three kilograms, but 20 days after a single injection of CAR-T cells, no sign of cancer was found. The challenge now is to reduce the exorbitant price of the treatment pharmaceutical companies charge more than 300,000 euros for each patient and make it work even in solid tumors such as the pancreas and brain.As June explains, passing through Madrid to deliver a speech at the Ramon Ares Foundation.

You use the word cure.

At 10 years old, yes. Our first two patients have already been free of leukemia for 10 years, so we can talk about a cure. They were cases like Lazaro. They thought they were about to die and both had the same reaction. When Bill Ludwig was told he no longer had leukemia, he bought a motorhome and traveled around the country with his wife, enjoying a vacation he had never had. The second patient, Doug Olson, is a scientist. When they told her that she no longer had leukemia, she bought a sailboat. Both of them thought that they were going to die and started a new life.

Compare these cases with Lazarus, the man who died and was resurrected by Jesus Christ in the Bible.

They thought they were going to die. Bill Ludwig had already paid for his funeral. Between 1997 and 2000, during the AIDS epidemic, I have seen something similar in medicine. Since there was no medicine, people who had AIDS died. Until effective drugs arrived. I saw it with AIDS and now I see it with these cancer patients who thought they were already dead and suddenly, rapidly, they were cured.

I think in 10 years the cost of CAR-T treatments will be a tenth of what they cost now

Do you know how many lives the CAR-T treatments have saved?

We know that more than 10,000 people in the world have received therapy. And many others are being treated with the experimental protocol. There are currently about a thousand clinical trials going on with CAR-T cells in the world.

-You were the promoter of the first authorized CAR-T therapy called kimariyah, In Spain, pharmaceutical company Novartis has fixed the price of Kymaria at 320,000 euros per patient. Do you think its a fair price? [Carl June reconoce un conflicto de intereses, ya que posee la propiedad intelectual de patentes licenciadas a Novartis]

-When we talk about fair price, it varies depending on the country. Its kind of awful, but Americas insurance companies are willing to pay $130,000 a year [cifra similar al cambio en euros] For anything that inspires you to live another year in health. The value of a person can be reduced to euros or dollars. And in the United States and Europe it is about $100,000 a year. They have observed that CAR-T cells offer a very long survival time. And theyve also studied the treatments that are used today: Other myeloma treatments, not CAR-Ts, cost a million dollars per patient and, on top of that, most die. In fact, CAR-T treatment is cheaper than it is now, even though they charge 300,000 euros. having said that, Its still expensive. The cost has to be reduced.

-How?

The most expensive part of CAR-T is the human work: Highly specialized scientists produce cells on a case-by-case basis, If robots could do this, it would be very cheap. This has already happened with many other new technologies, which eventually became cheaper to manufacture on a large scale. Computers were also very expensive earlier. What will happen to the CAR-T cell in 10 years? I am sure that instead of creating people in a procedure that requires two weeks, the hospital itself will have a machine in which the patients blood will be drawn and the CAR-T cells will come out on their own. I think in 10 years they will have to spend a tenth of their cost.

A Spanish public hospital, the Clinique de Barcelona, has developed its own CAR-T treatment against acute lymphoblastic leukemia and multiple myeloma. The price of these public CAR-Ts is 90,000 per patient, Novartis and other big pharma seem to be making a huge profit margin.

Well, the data so far shows that none of these big companies are making money from these cell therapies. Novartis makes a lot of profit out of the rest of the drugs it sells. The cost of producing a standard drug may be 5% of the direct selling price. In the case of CAR-T it is much higher. For example, they make much less money selling CAR-T cells than selling aspirin. Manuel Juan [jefe de Inmunologa del Hospital Clnic] He spent about three months with us learning how to make CAR-T cells and he is a great person. This has achieved a very efficient process, but has cost the pharmaceutical industry a lot. Different companies have to improve and make it cheaper, because thats how innovation and competition work. Unfortunately, it will probably take 10 years to fix this problem.

The most expensive part of CAR-T is human work: Very specialized scientists produce cells on a case-by-case basis. If it can be done by robots, it will be much cheaper.

-Novartis CEO, vas narasimhaniwon last year about 12 million euros, Does this salary make sense given the exorbitant cost of CAR-T treatments?

-Novartis has over 100,000 employees. These big pharmaceutical companies spend a lot of money on research and some of their drugs are life changing. You want to do research to develop new products, but you also dont want to make obscene profits. The average cost of new cancer drugs is more than $100,000 per year. CAR-T cells are the most expensive cancer treatment, but cell therapy for the treatment of sickle cell anemia and thalassemia has just been approved. I think they charge $2.3 million. It is a treatment for a fatal disease, but it is expensive as it requires a bone marrow transplant. And its far more difficult to do genetic engineering with stem cells [precursoras de las clulas de la sangre en la mdula sea], It is the most expensive treatment in the United States right now. Sickle cell anemia kills you. It is the most common fatal genetic disease and occurs mainly in black people who do not have health insurance. So now we have a way to treat it, but of course nobody has $2.3 million.

Drugs dont work if people cant afford them.

-accurate. Technology is making it possible to do things that have never been done before, such as cell engineering. Its expensive, but it works. The question is how to make it fair. Ive been to Costa Rica three times and were going to start a trial to see if we can develop this technology in a middle-income country. Right now there are no trials with CAR-T cells in Central or South America, only in Europe, the United States, China and Japan.

A decade ago, you said in an interview That all research on CAR-T treatment was being done in universities. Now it is the companies that take advantage.

Yes, this is a common problem in the United States and Europe. Citizens pay with their taxes to educational centers for the development of these treatments, and then they pay again to receive therapy.

Citizens pay twice for the same medicine.

Yes, this is a problem that should be solved with policies. Science is top notch. Research is now taking place in both industry and academia. Ten years ago research was academic only. Pharmaceutical companies now make more money than the US National Cancer Institute, which doesnt mean they do the most innovative research.

There are about 300 types of cancer and each one has pain in the heel which makes it vulnerable

CAR-T therapies against leukemia, lymphoma and myeloma have been approved in many countries. What about solid tumors, such as tumors of the pancreas, brain, or lung?

-There are experimental trials with all of these, but none of these treatments are authorized. We need more research. Pancreatic cancer and brain cancer are two of the worst and are already progressing. We now have an exciting trial at the University of Pennsylvania, in which we are combining an oncolytic virusa virus modified to infect tumor cellsand CAR-T cells. Were Doing It With Ramon Alemanni [investigador del Instituto Cataln de Oncologa], which is in Barcelona. So far we have treated only one patient, but it is very exciting. This is for pancreatic cancer and ovarian cancer. I think were going to need these kinds of combinations to deal with solid tumours. It is far more difficult for the immune system to completely eliminate a solid tumor than it is for leukemia. There have been about a thousand trials of CAR-T now, its being tested on any cancer you can think of.

Do you think that in 10 years there will be effective CAR-T cells against solid tumors?

There are about 300 types of cancer and each one causes heel pain which makes it debilitating. unfortunately, We are not going to have a single cure for all cancers. I think what we will have is, for example, something that only works against ovarian cancer, that works against breast cancer, or against leukemia. For leukemia you only need a single infusion of CAR-T cells and thats it. In solid tumors it would be much more complicated. In a laboratory dish, CAR-T cells kill pancreatic cancer, but in people solid tumors have a wall around them that prevents CAR-T cells from penetrating. This blood is not present in the tumor.

Manuel Ansede. By

EL PAS, SL

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Cancer: "I See Patients Who Thought They Were Already Dead And Suddenly, They Are Cured", Says Father Of A Revolutionary Treatment - Nation...