London, UK, 28th September 2017 / Sciad Newswire / The US approval of Novartis's Kymriah for childhood leukaemia opens a dramatic new era of cancer therapy deploying powerful modified white cells (CAR-T cells) to selectively kill cancer cells. However, Kymriah and other expected first wave CD19-targeting CAR-T therapies only cover 1.4% of cancers in the US and about 1% of deaths, 6,500.
Even if all currently accessible blood cancers could be treated by current CAR-T therapies, this is still only 54,000 new patients in the US each year, of whom about 19,000 die. At the Kymriah price of US$475,000, this new market is potentially worth US$9bn.
Due to this success of CAR-T in leukaemia, 53% of T-cell clinical trials are aimed at the 10% of patients with blood cancers - and not all of those are currently treatable. Few clinical trials are seeking to extend T-cell therapy to the 1.2m patients who are diagnosed with major solid cancers annually.
The reason for this mismatch between investment and medical need is that CAR-T technology, as used in Kymirah, is very hard to adapt to attack solid cancers. This means that the current leaders in CAR-T development may not escape from a limited and probably highly competitive niche market so most patients may not benefit.
The two most likely current options for extending T-cell therapy to treat solid tumours are NKR CAR T-cell therapy and T-cell receptor (TCR) approaches. While both are in earlier clinical development, they may advance rapidly if they show promising results. Other promising technologies include BiTEs - novel, dual targeting monoclonal antibodies that grab T-cells and link them to cancer cells to activate the cancer killing response.
NKR CAR T-cell therapy targets the 'stress antigens' displayed by most cancer cells. NKR CAR treatment is now being developed by Celyad to target five solid cancers covering 550,000 new cases with 150,000 deaths a year in the US: a US$75bn potential market. Two blood cancers (MM and AML) also in clinical development could treat up to another 52,000 cases with 23,000 deaths. Initial results are expected soon.
The TCR therapy approach has exquisite specificity and cross-cancer versatility. Leading US CAR-T companies have early projects aimed at solid cancers but the lead company is Adaptimmune. TCR therapies may treat up to 350,000 patients with 91,000 deaths (US$45bn potential market). Individual TCR products potentially have cross cancer versatility but their tight specificities means that their use is constrained to patient subgroups.
As solid cancers are difficult targets to attack, these new T-cell therapies might be combined with BiTEs (like those from Immunocore) and checkpoint inhibitors - as already used to treat lung and skin cancers.
Edison's free report on T-cell cancer therapies is published in two parts:
- Part 1 gives a comprehensive and comprehensible overview of the challenges and potential of these various approaches. Click here for T-cell cancer therapies: Part 1
- Part 2 gives an in-depth review of the various technologies and the current level of understanding of these powerful and risky therapies. Click here for Part 2: T-cell cancer therapies: Part 2
The reports were produced by Edison Investment Research, sponsored by Celyad and written by expert healthcare analysts, Dr John Savin and Dr Daniel Wilkinson.
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 The B-cell cancers (acute lymphoblastic leukaemia (ALL) and diffuse large B-cell lymphoma (DLBCL)) targeted with CD19 and multiple myeloma (MM) targeted with B-cell maturation antigen (BCMA).
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