CAR-T cancer treatment, is it worth $1.2 million?

Recently, the first cancer patient in China who was treated with CAR-T cells was discharged from the hospital. Cancer is so terrible because it is difficult to cure with current methods and recurrence after surgery is a common phenomenon. Therefore, the recovery of this patient has opened up a new way for the treatment of cancer in the future. At this point, do you find it strange, what is this CAR-T? How much does it cost? If it is very expensive, is it worth it? Let's answer your questions one by one today!

01. What is CAR-T?

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Before explaining to you what CAR-T is, let me first tell you about immunotherapy.

A simple version of understanding immunotherapy:

Immunotherapy is an important part of the five major cancer treatments. Here we will give a systematic introduction.

Cancer is difficult to treat. Can we use our own immunity to treat cancer?

Before answering this question, let us first consider a question: what kind of disease is easier to cure?

I believe everyone must have many answers. Colds, inflammations, etc. can all be treated through immunity.

In fact, these diseases have one thing in common, that is, they are mostly caused by microorganisms, such as bacteria, viruses, etc. In our modern medicine, there is a very familiar concept called antibiotics. Doctors tell us that these diseases are cured because of the effect of antibiotics, but is it really so?

In fact, this is just a superficial phenomenon. In the treatment of microbial infections, antibiotics actually only control the reproduction of microorganisms and prevent them from continuing to expand their invasion areas. It is our body's immune system that really eliminates these pathogenic microorganisms.

You can use the picture below to simply understand how microorganisms such as colds are cured.

When the virus enters the human body, it multiplies in large numbers, destroys cells, causes various symptoms, and then we become sick.

Then, we take medicine or go to the hospital for an IV drip, but what is the effect? ​​It is to control them, just like temporary detention.

But the real executor is the human immune system. The immune system is the police of our body, and they have the power of life and death. When they receive the signal of invasion of pathogens, they rush to identify cells, which are infected by the virus and which are still healthy. After the identification is completed, they surround the infected cells and begin to eliminate them.

I believe that through the above content, everyone has some understanding of human immunity, that is, immunity is the police of the human body to maintain normal order. They patrol the human body and kill the infected cells after receiving the infection signal.

So, can cancer cells also be noticed by our immune system? In fact, they can. Our body's immune police are also patrolling diligently, and when they encounter cancer cells, they are constantly fighting against them.

However, many times, cancer cells grow very quickly and metastasize rapidly. This is because, compared with infections caused by exogenous pathogens, cancer cells are more scheming and more difficult to deal with.

We can make an analogy and compare cancer cells to a group of thugs, while normal cells are ordinary people. Then, the cancer cells, the thugs, have four major killer weapons to deal with our immune police.

The first trick: Disguise to avoid the immune system

The number of cancer cells in the human body is very large. When we find cancer shadows under X-rays or CT scans, in fact the number of cancer cells has reached hundreds of millions.

These cancer cells are all different, and some are particularly clever. For example, they can pretend to be normal cells, appearing kind on the surface but actually being bad inside. In this way, they deceive the immune police.

Killer weapon 2: Passivation of immunity

If they cannot escape immune surveillance, then they have a second method, which is to make the immune police become unresponsive.

We mentioned earlier that the immune police must first identify cancer cells and distinguish between cancer cells and normal cells before they can kill cancer cells. However, some cancer cells can secrete factors that can make immune cells dull. On the one hand, immune cells recognize cancer cells more slowly, and on the other hand, the killing power of immune cells is weakened. As a result, some cancer cells are left behind, while the rest grow wildly, which causes cancer cells to grow larger and larger.

Killer weapon 3: Hijacking normal cells

If the above two methods cannot effectively stop the immune police, then cancer cells will adopt a very scary strategy, which is to hijack normal cells.

Previous studies have shown that there are actually very few cancer cells in cancer lesions, perhaps only more than 20%, and the rest are normal cells hijacked by cancer cells. These normal cells have become accomplices of cancer after being hijacked. Just like criminals hijacking hostages, they make the immune police also very entangled, not knowing how to start.

Killer weapon 4: Kill immune cells

In addition to the above strategies, cancer cells have another ruthless method, which is to kill the immune police.

The popular PDL1 is related to this. Immune police often carry a suicide bomb called PD1 to prevent immune cells from killing normal cells. Once stimulated by a molecule called PD-L1 signal, the immune cells will commit suicide. Cancer takes advantage of this and activates this bomb, so the immune police are sacrificed and the cancer survives.

With the above four strategies, cancer cells have a greater ability to survive than many pathogens, and in many cases even the immune system is helpless.

However, as the basic force to maintain the body, the immune system fights against cancer very fiercely and will fight to the end. We can design new therapies to treat cancer based on the above four points.

This is the famous immunotherapy, and the currently known solutions are designed to address the above four problems, such as CART, PD1, and PDL1.

CAR-T is a chimeric antigen receptor T cell technology therapy, which uses T cells to kill cancer cells. CAR means chimeric antigen receptor modification.

It is equivalent to activating the immune cells and then killing cancer cells. Immune cells killing cancer cells is the best way.

This therapy is very effective in treating blood tumors. In one treatment in the United States, 25 children and 5 adults participated in the disease, and 27 of them were completely cured, and no cancer cells were found. This effect is simply amazing. In the words of American oncologist Grup, it is "unprecedented". This is a way to truly cure cancer and will become a milestone in cancer treatment. Currently, Novartis, the world's third largest pharmaceutical company, is using this therapy as one of the priority projects in its $9.9 billion research and development budget.

02. What about the price?

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At this time, some people raised questions, what is the price of this CAR-T? 1.2 million yuan, do you think it is expensive? But this is the normal price, not even high. After all, the prices of the two CAR-T approved abroad are 470,000 US dollars for Novartis and 370,000 US dollars for Kite. Converted, it is also 2.4 million RMB.

Why is CAR-T so expensive?

Because this is customized. Currently, all commercial CAR-Ts are customized, and the universal ones are still under development. Therefore, this customization is definitely not cheap.

Let’s talk about the CAR-T process.

First, we need to assess whether the patient is suitable for CAR-T. Once confirmed, we can start the specific steps.

In fact, CAR-T cannot be used for most cancers at present, which is very regrettable.

The most successful CART currently is CD19-CART, which mainly targets blood tumors such as non-Hodgkin's lymphoma and acute lymphoblastic leukemia.

Next, cells are isolated from the patient's blood and then purified to obtain the T-cells.

——This step begins the specific customization.

This step is actually a laboratory process that requires specialized experimenters to operate and cultivate, but there is also a considerable risk of failure.

Next, the gene is modified in the T cells. This step is very critical. The cells must be modified so that they can both recognize cancer cells and activate the chimeric antigens of T cells. This is how CAR-T is created.

Step 4: Amplify CAR-T to obtain a large number of CAR-T

Step 5: Transfuse it back into the body.

It can be seen that this is standard genetic engineering + personal customization, precision medicine. The whole process requires the participation of specific laboratories and doctors, and there is a high probability of failure. If it were not for emergency treatment, it might not have survived.

But this thing is one of the ultimate strategies for fighting cancer.

03. Is it worth it? —————

Is it worth it? Of course it is. Talking about eternal life? You are overthinking.

Why is it worth it?

This is a rare treatment that has evidence to date that it can cure a certain type of cancer, and the overall cure rate is very high.

You should know that in many cases, it is difficult to cure cancer with current methods, and recurrence after surgery is a common phenomenon, so the five-year survival rate was invented. Except for thyroid cancer and bladder cancer, which have a very good prognosis, many cancers may recur.

The world's first little girl to receive CART treatment, Emily Whitehead, received treatment in 2012 and has not relapsed for 6 consecutive years, thus becoming the 2017 Nature Person of the Year.

04. About CAR-T

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1. CAR-T currently still has certain risks, such as inflammatory response issues

For example, the successful case Emily Whitehead mentioned earlier was the first human CART clinical trial. A few days after CAR-T infusion, she developed a severe immune reaction called cytokine release syndrome.

2. CAR-T cannot target all cancers at present. It is very effective in leukemia and lymphoma, and even really "cures" cancer. You know, curing cancer is a luxury. However, its effect on solid tumors remains to be seen.

Finally, in my opinion, one of the ultimate treatments for cancer is immunotherapy. Chemotherapy and radiotherapy are both harmful to the body. The most powerful weapon of the human body against disease is its own immunity.

The safety system that protects the human body is absent during the development of cancer. This is because cancer blocks or even hijacks the human immune system to a certain extent, causing the human body to fail to detect cancer cells in time, allowing cancer to spread.

How to stimulate the human body's immunity to fight cancer has always been a direction of effort.

I believe that cancer can be conquered in the future!