The Netherlands Cancer Institute’s Post

Cutting-edge CAR-T cancer therapy is now made in India — at one-tenth the cost:- •The treatment, called NexCAR19, raises hopes that this transformative class of medicine will become more readily available in low- and middle-income countries. •A small Indian biotechnology company is producing a home-grown version of a cutting-edge cancer treatment known as chimeric antigen receptor (CAR) T-cell therapy that was pioneered in the United States. CAR-T therapies are used mainly to treat blood cancers and have burgeoned in the past few years. The Indian CAR-T therapy costs one-tenth that of comparable commercial products available globally. •A single treatment of NexCAR19, manufactured by Mumbai-based ImmunoACT, costs between US$30,000 and $40,000. The first CAR-T therapy was approved in the United States in 2017, and commercial CAR-T therapies currently cost between $370,000 and $530,000, not including hospital fees and drugs to treat side effects. These treatments have also shown promise in treating autoimmune diseases and brain cancer. •India’s drug regulator approved NexCAR19 for therapeutic use in India in October. By December, ImmunoACT was administering the therapy to paying patients, and it is now treating some two-dozen people a month in hospitals across the country. •It’s a dream come true,” says Alka Dwivedi, an immunologist who helped to develop NexCAR19 and is now at the US National Cancer Institute (NCI) in Bethesda, Maryland. Her voice becomes tender as she describes seeing the first patient’s cancer go into remission. These are people for whom all other treatments have failed, says Dwivedi. “They are getting cured.”

Manufacturing costs and time are a big hurdle. Great work with NexCAR19 and global collaboration.

Cutting-edge CAR-T cancer therapy is now made in India — at one-tenth the cost The treatment, called NexCAR19, raises hopes that this transformative class of medicine will become more readily available in low- and middle-income countries. A small Indian biotechnology company is producing a home-grown version of a cutting-edge cancer treatment known as chimeric antigen receptor (CAR) T-cell therapy that was pioneered in the United States. CAR-T therapies are used mainly to treat blood cancers and have burgeoned in the past few years. The Indian CAR-T therapy costs one-tenth that of comparable commercial products available globally. A single treatment of NexCAR19, manufactured by Mumbai-based ImmunoACT, costs between US$30,000 and $40,000. The first CAR-T therapy was approved in the United States in 2017, and commercial CAR-T therapies currently cost between $370,000 and $530,000, not including hospital fees and drugs to treat side effects. These treatments have also shown promise in treating autoimmune diseases and brain cancer. India’s drug regulator approved NexCAR19 for therapeutic use in India in October. By December, ImmunoACT was administering the therapy to paying patients, and it is now treating some two-dozen people a month in hospitals across the country. “It’s a dream come true,” says Alka Dwivedi, an immunologist who helped to develop NexCAR19 and is now at the US National Cancer Institute (NCI) in Bethesda, Maryland. Her voice becomes tender as she describes seeing the first patient’s cancer go into remission. These are people for whom all other treatments have failed, says Dwivedi. “They are getting cured.” “It’s very positive news,” says Renato Cunha, a haematologist at the Grupo Oncoclínicas in São Paulo, Brazil. He says the Indian product could pave the way for making advanced cellular therapies accessible to other low- and middle-income countries. “Hope is the word that comes to mind.” The product is also a reality check for researchers in high-income countries, says Terry Fry, an immunologist and paediatric oncologist at the University of Colorado Anschutz Medical Campus in Denver, who has advised the researchers involved in setting up ImmunoACT. “It lights a little fire under all of us to look at the cost of making CAR-T cells, even in places like the United States.” https://lnkd.in/edz2hZN9

Yesterday's announcement of $604 million investment over four years to fund up to 26 cancer treatments is fantastic news for New Zealanders living with cancer. We are very pleased to see that the announcement includes the fulfilment of a promise to fund 2 new cancer drugs for gut cancer patients. The funding of Atezolizumab & Bevacizumab (Tecentriq & Avastin) is a major milestone for patients with advanced, unresectable hepatocellular carcinoma (liver cancer). For the first time, patients in Aotearoa will have access to an active, first-line treatment option as opposed to the current approach for these patients of providing the best supportive care. Funding for Cetuximab (Erbitux) or Panitumumab (Vectibix) in combination with chemotherapy as a first-line therapy is the first time in over 20 years a new medicine has been made available for bowel cancer patients. This new treatment will be available for patients with metastatic, RAS wild-type colorectal cancer. We are yet to receive specific information as to when these new treatments will be made available and will update as soon as we know more. Today's announcement also indicated that another 13 currently unnamed cancer treatments will also be funded. Pharmac will use the money provided to fund treatments currently listed on its 'Options For Investment' list. Currently there are number of gut cancer drugs on this list, including: - Pembrolizumab/ Keytruda (unresectable or metastatic deficient mismatch repair (dMMR) colorectal cancer) - Durvalumab/ Imfinzi (Biliary tract cancer) - Nab-paclitaxel/ Abraxane (Pancreatic Cancer) - Bevacizumab/ Abevmy (metastatic colorectal cancer) - Ripretinib/ Qinlock (Gastro-intestinal stromal tumour). At this stage we do not know if any of these drugs will be funded, or when we will know if Pharmac will fund them. We also note that there remains an onus on Te Whatu Ora/ Health New Zealand to plan and fund the services around implementation of these new treatments - care for cancer patients including administration and monitoring requires a skilled staffed workforce and gaps in recruitment remain around the country. In summary, we are delighted that the pre-election commitments made to liver and colorectal cancer patients have been fulfilled. We will continue to keep pushing for those treatment options that have not yet been funded and will keep you updated as we receive news.

Cancer is one of the leading causes of death worldwide, but it is often diagnosed too late, when the chances of a cure are slim. For this reason, many researchers are trying to develop blood tests that can detect the presence of cancer cells before they form a visible mass or cause symptoms. These tests, called multi-cancer screening tests, are based on the recognition of specific molecules produced by cancer cells, such as DNA or proteins. One of the most promising tests was developed by a Californian company, Novelna Inc, which published its results in Bmj Oncology. The test is based on a panel of 10 proteins that are different between men and women and that are associated with 18 types of cancer affecting the body's major organs. The test is able to distinguish between cancer patients and healthy ones with high accuracy, especially for early-stage cancers, which are the most difficult to detect. In addition, the test is able to identify the tissue of origin of the tumour, i.e. the organ from which it started, with an accuracy of more than 80%. This test represents a great innovation in the field of early cancer detection, because it takes into account differences between the sexes, which are important for both prevention and treatment. In addition, the test is simple, quick and inexpensive because it only requires a blood sample and the use of technology based on antibodies, which are molecules that can specifically recognise proteins. The test could therefore be used as a mass screening tool, to detect cancer cases before it is too late and to offer patients the best treatment options. Novelna Inc's test is just one of many that are trying to exploit the potential of blood as a source of cancer information. Other tests are based on the detection of tumour DNA, which is different from normal DNA and can be found in small amounts in blood. These tests can detect more than 50 types of cancer, but have the problem of being less sensitive for early-stage tumours and being more expensive³. The comparison between the different tests is still ongoing and requires further clinical studies to assess their effectiveness and safety. The ultimate goal of these tests is to save lives by reducing cancer mortality. Cancer, in fact, is a disease that can be cured if detected in time, but becomes very aggressive and resistant if allowed to progress. With blood tests that can detect cancer before it occurs, early and targeted intervention could be possible, increasing the chances of cure and improving the quality of life of patients. These tests could also help prevent cancer by identifying people at risk and suggesting preventive measures, such as lifestyle changes or specific medications. In this way, cancer could become an increasingly rare and manageable disease.

Cancer is a disease characterized by abnormal cell division and proliferation that result from disruption of molecular signals that control these processes. Cancer is the abnormal, uncontrolled division of cells in the body. The cancer cells when malignant, invade various parts of the body through the bloodstream. The spread of cancer from its cells or tissue of origin to another healthy part of tissues or organs is called metastasis. Some of the regular characteristics of cancers are apoptosis, angiogenesis, multiple replication, growth signal production, insensitivity to signals of anti-growth, and metastasis. These features allow cancer cells to have continuous growth, long-term survival, and the potential to invade normal cells. Moreover, if these activities are not blocked, cancer cells will continue to increase, overwhelm, and finally kill the patient with cancer. Oncology is the study of cancer. An oncologist is a doctor who treats cancer and provides medical care for a person diagnosed with cancer. An oncologist may also be called a cancer specialist. Today, despite considerable efforts, cancer remains an aggressive killer worldwide. The success rate of these therapies is diminished by toxicities, drug resistance, recurrence and treatment failure. A significant challenge associated with cancer is that treatment is as much an art as it is a science. Therefore, there is a constant demand to develop new, effective, and affordable anticancer drugs. Several factors, such as environmental factors, habitual activities, genetic factors, etc., are responsible for cancer. Many cancer patients seek alternative and/or complementary treatments because of the high death rate linked with cancer and the adverse side effects of chemotherapy, radiation therapy, immunotherapy, surgery, and stem cell therapy. Medicinal plants could also possess effective anticancer compounds that may be used as adjuvants to existing chemotherapy to improve efficacy and/or reduce drug-induced toxicity; such as chemotherapy-induced nausea and vomiting to improve patients’ quality of life. Cell death is caused by the whole plant extracts via apoptosis. However, the majority of plant extracts have been researched for cancer prevention rather than treatment, resulting in low efficacy and uptake in practice. Prevention is certainly an attractive cancer management strategy. Thus it might be possible to reduce the process of carcinogenesis with regular use of these plants along with a healthy lifestyle.

Cutting-edge CAR-T cancer therapy is now made in India — at one-tenth the cost The treatment, called NexCAR19, raises hopes that this transformative class of medicine will become more readily available in low- and middle-income countries. A small Indian biotechnology company is producing a home-grown version of a cutting-edge cancer treatment known as chimeric antigen receptor (CAR) T-cell therapy that was pioneered in the United States. CAR-T therapies are used mainly to treat blood cancers and have burgeoned in the past few years. The Indian CAR-T therapy costs one-tenth that of comparable commercial products available globally. A single treatment of NexCAR19, manufactured by Mumbai-based ImmunoACT, costs between US$30,000 and $40,000. The first CAR-T therapy was approved in the United States in 2017, and commercial CAR-T therapies currently cost between $370,000 and $530,000, not including hospital fees and drugs to treat side effects. These treatments have also shown promise in treating autoimmune diseases and brain cancer. India’s drug regulator approved NexCAR19 for therapeutic use in India in October. By December, ImmunoACT was administering the therapy to paying patients, and it is now treating some two-dozen people a month in hospitals across the country. Purchasing enough lentiviral vector for a trial of 50 people can cost up to US$800,000 in the United States, says Steven Highfill, an immunologist at the US National Institutes of Health Clinical Center in Bethesda, who has advised the Indian team. Scientists at ImmunoACT make this gene-delivery vehicle themselves. The Indian team also found a cheaper way to mass-produce the engineered cells, avoiding the need for expensive automated machinery, says Highfill. Patients’ costs are further reduced by the therapy’s improved safety profile compared with some of the other FDA-approved products, Purwar says. This meant that most patients did not need to spend time in intensive-care units. Purwar hopes to further cut costs, including by scaling up production. ImmunoACT is planning to export the therapy to Mexico, and to develop new products, including a treatment for another form of blood cancer known as multiple myeloma. But ImmunoACT faces competition. Several other Indian companies have launched local CAR-T trials, including Immuneel Therapeutics in Bengaluru, which has licensed technology developed by Spanish academics. https://lnkd.in/g7gjrmKB

As many of you may already know, I am actively involved in a campaign to raise awareness and support for those affected by blood cancer as a nominee for Visionary of the Year! The Leukemia & Lymphoma Society (LLS) is at the forefront of this battle, working tirelessly to find cures and improve the quality of life for patients. Without their fight to cure cancer, we wouldn't have made all the advancements when it comes to the knowledge about blood cancer. Starting March 28th - June 8th, we have a significant opportunity to make a real impact. I cannot do this without my cherished network & honestly, I don't want to wait for March 28th to come to start spreading the word! So - this fight is not really WHY, it's why not? Here are just a few of the many advancements LLS alone has been able to make with the support of these campaigns: Myeloma: Adding the anti CD38 antibody daratumumab to the standard treatment regimen in patients with newly diagnosed multiple myeloma led to significantly higher survival rates without disease progression (84.3%) compared to standard care alone (67.7%) Mantle cell lymphoma: Combining the BTK inhibitor ibrutinib with the B-cell lymphoma-2 inhibitor venetoclax for relapsed or refractory mantle cell lymphoma improved progression-free survival to 33 months compared to 22 months for ibrutinib alone. Acute myeloid leukemia: Patients with an AML mutation called KMT2A fusion, who have among the worst AML outcomes, had improved overall survival and complete hematological response after menin inhibitor treatment. This is one of the two menin inhibitor drugs likely to be evaluated for approval soon by the FDA. Myelofibrosis: After years of having nothing but supportive care to offer people with myelofibrosis, there are several late-stage drug trials in progress. One trial reported at ASH showed that combining the kinase inhibitor ruxolitinib with a BET inhibitor called pelabresib significantly improved debilitating symptoms in people with myelofibrosis: anemia and an enlarged spleen. Look for a possible FDA drug approval for pelabresib in 2024. CMML: Rare cancers like CMML are difficult to study. There are fewer patients available for clinical trials, median survival time is just 30 months, and up to 3 in 10 patients will convert to having AML. There is a major effort underway, led by LLS and supported by the Segal Family Foundation, to test new treatments and dig deeper into understanding mechanistically how CMML forms and attacks the body. We expect an acceleration in our understanding of CMML in 2024 and beyond. Your involvement can truly make a difference & we can make the biggest impact, together. Thank you for considering this important cause & please continue to follow my post for further updates/ sponsorship opportunities.

𝗔 𝗻𝗲𝘄 𝗰𝗮𝗻𝗰𝗲𝗿 𝘁𝗿𝗲𝗮𝘁𝗺𝗲𝗻𝘁 𝗽𝗿𝗼𝗺𝗶𝘀𝗲𝗱 𝘁𝗼 𝗰𝘂𝘁 𝘁𝗿𝗲𝗮𝘁𝗺𝗲𝗻𝘁 𝘁𝗶𝗺𝗲 𝗱𝗼𝘄𝗻 𝘁𝗼 𝗷𝘂𝘀𝘁 𝗺𝗶𝗻𝘂𝘁𝗲𝘀 (𝗡𝗲𝘄𝘀 𝘄𝗮𝘀 𝗿𝗲𝗹𝗲𝗮𝘀𝗲𝗱 𝗧𝗢𝗗𝗔𝗬)🤫 A new cancer treatment recently approved in Canada promises to cut treatment time down to just minutes, but experts have differing opinions on whether it's what's best for patients. One fears that it will unnecessarily use a higher dose of an existing drug and is likely to be pricier than the current method of administrating it intravenously. By contrast, another oncologist says it is a welcome development that can drastically reduce the time for cancer treatment. Health Canada approved the sale of Tecentriq SC last month, a prescription medication that treats patients with lung cancer, liver cancer and breast cancer in a new subcutaneous formulation of the already approved drug atezolizumab. Atezolizumab is currently used in intravenous form as Tecentriq IV to treat various tumours. The new subcutaneous type of cancer immunotherapy treatment injects the drug under the skin instead of intravenously into the veins. Mississauga, Ont.-based pharmaceutical company Roche Canada said in a news release last week that the Tecentriq subcutaneous injection helps to strengthen the immune system's ability to fight cancerous cells. The company told CTVNews.ca that it's the first cancer immunotherapy subcutaneous injection for multiple cancer types in Canada. This treatment has been approved in more than 30 countries. Switzerland-based pharmaceutical giant F. Hoffmann-La Roche Ltd. is Roche Canada's parent company. The information you need to know, sent directly to you: Download the CTV News App New immunotherapy seen as time-saver In addition to boosting the immune system, another potential benefit to patients is the flexibility this new treatment offers. Roche Canada said the Tecentriq subcutaneous injection must be administered by a qualified health-care professional, but this could be done outside of a hospital, in another facility or even at a patient's home. Sharlene Gill, president of the Canadian Association of Medical Oncologists, said in a video interview with CTVNews.ca the subcutaneous formulation would reduce the time to treat patients who typically receive immunotherapy for a long period. Administering subcutaneous injection under the skin could be done faster, such as in about 15 minutes compared to about an hour through IV, she explained. "I'm not sure I would call it a game-changer, but I would say that this really matters to people in terms of: it may not be a new medicine, but it's a better way of being able to deliver a highly effective medicine," said Gill, who is also a professor of medicine at the division of medical oncology at the University of British Columbia in Vancouver. Continue reading on Flipboard.com

Some cancer treatments are straightforward and some are train wrecks When you’re newer to oncology, you’re usually learning fairly simple patient scenarios. But in the real world, our patients don’t usually fit in nice little boxes. A member of the ELO Collaborative shared this challenging situation asking for feedback 👇 A 70 year old patient being treated for multiple myeloma with bortezomib + lenalidomide + dexamethasone has a new melanoma diagnosis. She was asked if the patient can remain on her myeloma treatment while getting dual immunotherapy for melanoma. Although it’s uncommon to have multiple primary cancers (meaning they aren’t related to each other), you’ll probably see it more than you expect How would you approach answering this? It’s not a question you can Google 😳 (also why you won’t be replaced by AI anytime soon) This is the real test of learning oncology and why your training and education is so important You need to be able to think critically about a scenario, pull in lots of information and make an informed recommendation based on what you know about the diseases, treatments, and the patient’s history. When answering a question like this, consider: 👉 Which disease is more pressing? Myeloma is an incurable disease and we know that immunotherapy in melanoma are the most effective agents. We don’t know how long the patient has been on therapy or what their presentation was - if they are newly diagnosed with lots of end organ disease, it gets even more challenging. 👉 Does the pathophysiology of the diseases come into play? Myeloma is caused by the monoclonal production of plasma cells which causes dysregulation of the immune system. Its treatments are trying to tamp DOWN the problem parts of the immune system. The job of immunotherapy is to ramp UP the immune system to get it to recognize foreign cancer cells. Not ideal to have opposing mechanisms… 👉 What could happen if you continue therapy for both diseases? Does one regimen interfere with the other, either making it more toxic or less effective? We know immunotherapy, especially dual immunotherapy, can cause any number of immune-related adverse effects, some incredibly toxic and potentially fatal. There is no right answer to questions like these This is why developing a deep baseline knowledge of oncology is important. Yes, we are pharmacists, but we can’t just know about the drugs. We have to understand how the drugs play into the larger ecosystem of the disease. What other angles need to be thought about in this case? --- 📌 When you’re ready to build that deep baseline knowledge, Check out the Enjoy Learning Oncology (ELO) program 👉 https://lnkd.in/gTRvKSQS I’m the Kelley in KelleyCPharmD 👋 and I help pharmacists learn the complex world of oncology #LearnOncology #Pharmacists #OncologyPharmacists #ClinicalPearls #Oncology