The future of affordable cancer immunotherapy  -  06 September 2023

Derived from:   https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2023.1248867/full

Citation:   The future of affordable cancer immunotherapy. Front. Immunol. 14:1248867. doi: 10.3389/fimmu.2023.1248867

Schaft N, Dörrie J, Schuler G, Schuler-Thurner B, Sallam H, Klein S, Eisenberg G, Frankenburg S, Lotem M and Khatib A (2023) 

The treatment of cancer has been revolutionized within the last two decades by utilizing the mechanism of the immune system against malignant tissue in so-called cancer immunotherapy. 

Two main developments have boosted cancer immunotherapy: 

1) the use of checkpoint inhibitors, which are characterized by a relatively high response rate mainly in solid tumors; however, at the cost of serious side effects, and 

2) the use of chimeric antigen receptor (CAR)-T cells, which were shown to be very efficient in the treatment of hematologic (blood) malignancies, but failed to show high clinical effectiveness in solid tumors until now. 

Now active immunization against individual tumors is emerging, and the first products have reached clinical approval. 

These new treatment options are very cost-intensive and are not financially compensated by health insurance in many countries. 

Hence, strategies MUST be developed to make cancer immunotherapy affordable and to improve the cost-benefit ratio. 

In this review below, the authors discuss the following strategies: 

1) to leverage the antigenicity of “cold tumors” with affordable reagents, 

2) to use microbiome-based products as markers or therapeutics, 

3) to apply measures that make adoptive cell therapy (ACT) cheaper, e.g., the use of off-the-shelf products, 

4) to use immunotherapies that offer cheaper platforms, such as RNA- or peptide-based vaccines and vaccines that use shared or common antigens instead of highly personal antigens, 

5) to use a small set of predictive biomarkers instead of the “sequence everything” approach, and 

6) to explore affordable immunohistochemistry markers that may direct individual therapies. 

1 Introduction

Immunotherapy has changed the cancer treatment scenario and revolutionized tumor immunology. Immunotherapy treatments, such as adoptive T-cell therapy (ACT) or the use of immune checkpoint inhibitors (ICIs), are now well-established components of the toolbox of cancer treatments, significantly improving longevity in a substantial proportion of patients.

However, with the advancing success of cancer immunotherapy, it is becoming clear that a significant drawback of current immunotherapies is their high expense. 

To enable the wider usage of immunotherapy:

efforts will eventually have to be centered on developing immunotherapy treatments that are significantly cheaper and affordable to larger populations worldwide. 

Getting a cancer immunotherapy treatment costs more than a house in many cities in the US....... 

The average cost of cancer drugs increased from $50,000 per patient in the mid-1990s to $250,000. 

That is four times the median US household annual income. 

Immunotherapies often cost more than $100,000 per patient. 

For some of the newest immunotherapies, the price tag is even steeper: 

When including the value of the medical support necessary to deliver these treatments, a price tag of $850,000 per patient is not unheard of (4). 

For example, although the wholesale acquisition cost of CAR-T-cell therapies to treat B-cell lymphoma is $373,000, 

a new study by Prime Therapeutics of real-world data found that the total cost averages more than $700,000 and can exceed $1 million in some cases (5). 

Increasingly, approaches to treat solid tumors and hematological (blood) malignancies involve the concurrent administration of several products with distinct but complementary mechanisms of action in combination or in close sequence as part of a regimen 

The use of combined immunotherapies means that costs can quickly double or triple. 

Some recent examples include: 

• the addition of pertuzumab to trastuzumab for the treatment of human epidermal growth factor receptor-2 (HER-2)-positive breast cancer and 

• the use of programmed cell death protein (PD-1) and programmed cell death ligand (PD-L1) inhibitors in combination with anti-cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) therapies in metastatic melanoma. 

This trend presents serious challenges for Health Technology Assessment (HTA) bodies and payers. 

Combination regimens are expected to increase over the next few years (7, 9). 

Almost all information regarding the costs of immunotherapy is based on data from OECD countries; however, access to oncology medicines remains unequal across OECD/EU countries. 

The charges in non-OECD countries will probably be higher and may enjoy less support from health or insurance institutions or drug companies. 

Additionally, there is little doubt that the population of third-world countries will mostly be unable to cope with such expenses.

The future of cancer immunotherapy will largely depend on the ability of researchers to make it affordable to larger populations. 

This review summarizes some scientific suggestions for making this happen........ 

https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2023.1248867/full

Citation: Schaft N, Dörrie J, Schuler G, Schuler-Thurner B, Sallam H, Klein S, Eisenberg G, Frankenburg S, Lotem M and Khatib A (2023) The future of affordable cancer immunotherapy. Front. Immunol. 14:1248867. doi: 10.3389/fimmu.2023.1248867

Received: 27 June 2023; Accepted: 11 August 2023;
Published: 06 September 2023.