Too Many Possible Treatments for Blood Cancers?

Fierce Pharma had a fascinating article this week called "An abundance of CAR-Ts: $37B cell therapy cancer market can't support 'congested' pipeline, report says." It's actually a commentary on a report from a company called GlobalData. 

The bottom line is this: Because of the success of CAR-T for blood cancers (not just Follicular Lymphoma, but several blood cancers), lots of companies are developing their own versions of CAR-T and other cellular therapies. There's just no way that all of those treatments will be possible.

Right now, according to the report, there are about 800 different cellular therapies in "the pipeline," in different stages of development. These include mostly CAR-T treatments, but also some others, like CAR-NK (which use Natural Killer cells instead of T cells) and TILs (Tumor-Infiltrating Lymphocytes). They all work in the same general way, using immune cells to kill off cancer cells. The report looks at five different blood cancers (not FL specifically, but all B Cell Lymphomas).

It's all pretty interesting. As I said in my last post, even though it seems like I've been writing lately about treatments that aren't going to be approved, it's important to remember that fewer than 10% of treatments ever make it to the treatment room. So in some ways it's not surprising that there are so many CAR-T treatments being developed. There's no way they'll all make it.

But it's also a little problematic. 800 treatments means there are a lot of resources being put into something that might be better used somewhere else. Every one of those treatments will need to be at least a little bit different from what is available. And that's certainly possible -- even the CAR-Ts that are available now have improved in the few years since approval. There is always room for improvement. But it seems like too much money, and too many smart people, working on the same problem. 

The report gives an example: most of the CAR-T treatments being developed are autologous. In other words, they use an individual patient's own cells to develop the treatment. There are not nearly as many allogeneic, or "off the shelf" treatments being developed. These are the kind of treatments that use one set of cells that might be given to any patient (or to many patients). The time and expense of developing an individual treatment would be gone. Cheaper and easier. 

Unfortunately, that's not where the resources are going. CAR-T treatments are autologous, and they are very popular, so that's what we'll develop. 

I think the GlobalData report is mostly aimed at those in the pharmaceutical industry, as a warning that this trend could bring problems. 

But that warning is very important for us as patients, too. As I have been saying, resources are probably going in the wrong direction. I think about the problems with PI3K Inhibitors, and so many of them being pulled (or pulling themselves) from the market all at once. Part of the problem was safety issues that came up. But the other part of the problem was the difficulty the companies were having in getting patients into clinical trials so they could provide more data for the FDA. When there are multiple treatments that essentially do the same thing, at some point, there aren't going to be enough patients around to test them. (And I know that the PI3K inhibitors were all slightly different, but obviously not different enough.)

So that's the potential lesson here -- at some point, we're going to have too many choices. I've made this point before: it seems like the treatments that the Lymphoma community are getting most excited about are things like CAR-T and Bi-specifics. One of the things that makes them exciting is that they tend to have long PFS -- Progression Free Survival. They may not necessarily increase Overall Survival, keeping us alive longer. But they do result in longer times between treatments. That means a better Quality of Life. 

It seems to me that the future of FL will mean fewer treatments for us during our lifetimes. That means fewer overall available treatments will be necessary. So the smart move would be for a company to look in new directions, and not offer a slight variation of what's already available. Rituxan was approved in 1997. There have been a whole lot of attempts to improve on it, with darn few successes. Doctors still use it because it's what they are used to. There's a lesson there. 

Of course, this is a good time to remind everyone that I am not an oncologist or a biologist or cancer researcher. Just a patient who reads a whole lot. 

But I also have a heavy interest in seeing new treatments be successful. I hope I'm right about a few things -- that treatments get better, and better treatments become available to us.