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Novartis’ breakthrough cancer treatment receives FDA advisory approval

Published on 13/07/17 at 11:13am

In what could well be a game-changing decision for cancer treatment, the FDA advisory panel gave Novartis’ CAR-T Therapy, CTL019 (tisagenlecleucel), unanimous approval in a 10-0 vote in favour of the treatment.

Novartis revealed Phase 2 data from a small study of patients that displayed ground-breaking efficacy in treating patients with acute lymphoblastic leukaemia, with 83% of patients in complete remission three months after treatment.

The patients were mainly children and young adults that had no treatment options left. The dramatic results in many of those who took the drug produced huge enthusiasm about the possibilities this may open up, with one expert, Tim Cripe, an oncologist at the Nationwide Children’s Hospital and member of the advisory panel, declaring: “this is the most exciting thing I’ve seen in my lifetime”.

The treatment works by harvesting T cells from the patient, reengineering them to hunt the patient’s cancer cells and then releasing them into the body. Once the T cells are introduced into the body, where they multiply and are able to hunt cells expressing a particular antigen – allowing for a precision targeting of the cancer cells.

This does not mean that the drug is not without its side-effects, with all patients who had their cancer sent into remission also developing a condition called B-cell aplasia. There is also the threat of cytokine release syndrome, where the body’s reacts with a systemic inflammatory response, giving patients flu-like symptoms that can worsen to be life-threatening.

Despite these acknowledged risks, the advisory committee saw enough potential therapeutic benefit to vote in favour of the drug. It is understandable why this decision was reached, as patients who received the treatment would otherwise be at the end of the road for further therapy.

Another major question mark that hangs over treatment, at present, is the potential cost. It is likely to be in the hundreds of thousands per patients, who will then likely have to receive further medication to manage issues, such as B-cell aplasia, as a result of the treatment. NICE estimated that such treatments would be likely to cost £500,000 per treatment.

Even then, there is the question of how profitable the technology would be to Novartis, as the particular sub-group of patients within leukaemia would be as little as several hundred patients, annually.

That will not faze the company unduly, as there are plans to expand the treatment to address further blood cancers. As well as this, technology in the area is improving rapidly – with time needed to develop the treatment alone having dropped from an initial six weeks to 22 days, as revealed during the panel discussion.

The decision by the panel will have been welcomed by Kite Pharma, a company that is also awaiting its own regulatory review of its CAR-T treatment. It is at a similar stage, where data is still relatively limited and the decision will provide them hope that impressive efficacy statistics are enough to hold other doubts in an area of urgent need.

It is expected that an official decision will be reached by the FDA on the drug by October.

Ben Hargreaves

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