Renier Brentjens, MD, PhD, on Barriers to Accessibility for CAR-T

This is the third part of an interview with Renier Brentjens, MD, PhD. For the first part, click here. For the second part, click here.

“Look, I'm a leukemia doc. I spent years giving high dose chemotherapy to our leukemia patients... So it's not that I'm not empathetic to the toxicities that these cells can cause—I certainly am, and we certainly have developed algorithms to minimize those toxicities—but I think most of what we do as medical oncologists with anychemotherapy is fraught with tons of toxicities, and so we have to accept that, and we have to deal with it. For now, I don't think it's a reason to stop developing this technology.”

Chimeric antigen receptor T-cell (CAR-T) therapy has proved to be an effective tool in the toolbox for addressing hematologic malignancies, having now been incorporated as a standard part of the landscape of care. Furthermore, efforts to bring the modality to solid tumors, with necessary modifications to address the unique challenges of those tumor types, are now underway.

Although, several aspects of CAR-T may limit its accessibility. Two important considerations are the potential toxicity caused by the therapy and the high cost of manufacturing CAR-T products. A myriad of research and development programs intended to mitigate these drawbacks are now underway across an array of companies and institutions.

During a broader discussion on the future of CAR-T therapy, CGTLive® asked Renier Brentjens, MD, PhD, the chair of the department of medicine and the deputy director at Roswell Park Comprehensive Cancer Center, for his thoughts on the barriers to accessibility to CAR-T and how the field is dealing with them. Brentjens emphasized that while adverse reactions associated with CAR-T like cytokine release syndrome are serious, they’re manageable. Furthermore, he pointed out that at the moment, toxicity is essentially a fact of life for the field of oncology, as other standard of care modalities like chemotherapy also have toxicities strongly associated with them. Therefore, toxicity alone should not be a reason to stop developing new CAR-T treatments.

With regard to cost, Brentjens stated that costs for CAR-T are likely to go down over time as the technology develops and more products enter the commercial market. Although, he gave his view that academics engaged in research and development for CAR-T products should focus first on developing products capable of effectively eradicating metastatic tumors before shifting the focus to bringing down costs.