A NEW HOPE
Sometimes to smash brick walls you have to build multi-million dollar, pressure-resistant ones containing steel cages.
Within the four walls of the Malaghan Institute of Medical Research in Wellington, tests will soon be run on a brand-new blood cancer treatment that genetically modifies living human cells.
Taken from the blood of sick leukaemia patients, the cells will be ‘‘played with’’ in $2 million vacuum-sealed, custom-built laboratories before going back into the patient.
Professor Graham Le Gros, Malaghan’s director, said this was known as CAR-T cell therapy – a branch of immunotherapy that makes Malaghan as significant to medical science as the Weta empire is to New Zealand film.
‘‘We’re dealing with living cell medicines here. We’re pioneering a totally new way of therapy,’’ he said. ‘‘Let’s be bold and say: safely genetically modifying [cells], and it goes into people and it’s living.’’
Developed in China and FDAapproved in the United States, trials of CAR-T therapy have seen remission rates of more than 80 per cent for some blood cancers.
The end goal is to administer those cells via what is basically a vaccine – but one that is tailormade to each patient.
But because it is bespoke treatment, drug companies have not seen much profit in it, until recently when the likes of the highly-publicised melanoma immunotherapy, Keytruda, hit the market.
‘‘Drug companies said ‘if we make Voltaren, it costs us 2 cents to make and there’s 98c profit on the damn thing. You can’t make money on this Keytruda, blah blah blah’,’’ Le Gros said.
‘‘Drug companies are the most conservative things because they’re totally driven by shareholders.’’
But recent data – largely led by philanthropists and grants from the likes of the Health Research Council – made way for innovative, ‘‘risky’’ immunotherapy.
‘‘A lot of people were believing you could do cancer treatment with chemotherapy alone and just kill the cancer. It never worked,’’ Le Gros said.
‘‘I think immune therapy has been given an incredible lease on life now because they say ‘hey, let’s stop trying to cure a cancer cell, let’s work out what’s going wrong with the body in the first place’.
‘‘If you get the immune system right, the body comes right.’’
Immunotherapy also brings hope for asthma, allergies and auto-immune conditions such as eczema, inflammatory bowel diseases, multiple sclerosis and type 1 diabetes.
Malaghan Institute director Professor Graham Le Gros and human immunology lab clinical director Dr Robert Weinkove explain their work.
What is immunotherapy? Graham Le Gros: Immunotherapy is treatment that is designed to harness the ability of the body’s immune system to combat infection or disease. Immunotherapy might produce an immune response to disease, enhance the immune system’s resistance to active diseases, or suppress an immune response.
What is CAR-T therapy?
Rob Weinkove:
Chimeric antigen receptor (CAR-T) cell therapy is a revolutionary new approach to fighting cancer. It redirects a patient’s own immune cells to impart long-lasting protection against the disease.
How does the CAR-T therapy work?
Weinkove: CAR-T cell therapy involves modifying patients’ immune cells (T cells) in the laboratory, to redirect them against cancer cells.
The modified T cells are then returned to the patient where they can attack and destroy cancer cells. Where else in the world can people can get this treatment? Weinkove: There are many trials of this kind of treatment worldwide, and the safety profile of these treatments is beginning to be well understood.
Some second generation CAR-T cell therapies are licensed for use in the United States and Europe for certain types of leukaemia and lymphoma.
The treatment we are working on has been developed as a thirdgeneration CAR-T cell therapy. We hope it will be more effective or easier to deliver than the treatments currently available elsewhere. What would it cost a Kiwi to get this treatment abroad? Weinkove: Overseas, CAR-T therapy costs about US$350,000 (NZ$495,176) to US$475,000 (NZ$672,025) for the cells alone, and sometimes as much again for the administration.
If clinical trials are successful here, would this treatment still be just as expensive? Weinkove: It is our aim that any CAR-T cell treatment offered in New Zealand, in which we are involved, will cost less than what it costs patients for this treatment overseas. How many people are you wanting to take part in the trial? Weinkove: Early phase studies are typically small – we wouldn’t expect to treat more than 10 to 12 patients in our first clinical trial in New Zealand.