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CAR T cell therapy: potential for considerable savings

No. 40 | 23/06/2020 | by Koh

Chimeric antigen receptor (CAR) T cell therapy is a new and in some cases highly effective form of immunotherapy to treat certain types of cancer of the blood and lymph system. This promising treatment comes at a cost, however: The manufacturers charge up to EUR 320,000 for the production of immune cells for a single patient. By determining the fixed and variable costs involved, researchers from the German Cancer Research Center (DKFZ) established that cellular immunotherapy could be produced at a scientific institution such as DKFZ at around a tenth of the cost.

DKFZ employees examining CAR T cells under the microscope in a clean room
© Eichmüller/DKFZ

For several years now, physicians have been achieving considerable success using an innovative form of immunotherapy in patients with certain types of cancer of the blood and lymph system: The treatment involves harvesting immune cells (T cells) from the patient and modifying them outside the body to make them more effective in attacking the malignant leukemia cells. To do so, the researchers equip the cells in the laboratory with a specific receptor protein. This chimeric antigen receptor (CAR) recognizes a protein molecule as a target structure that is formed by every cancer cell in certain types of leukemia. The CAR T cells are subsequently propagated and transferred back to the patient – where they hunt down malignantly transformed leukemia cells, sometimes with spectacular success.

Two commercial CAR T cell products have been approved to treat patients with acute lymphoblastic T cell leukemia and non-Hodgkin lymphomas such as diffuse large cell B cell lymphoma. They are only used if other treatment options have failed. The treatment is often effective: two years after treatment, 40 to 60 percent of patients have not relapsed.

This promising and highly individualized treatment comes at a cost, however: In Germany, the manufacturers charge up to EUR 320,000 for the production of CAR T cells for a patient. "CAR T cell therapy is still only feasible in a few cancer patients, but this treatment approach will hopefully be able to be extended to other types of cancer. There is considerable concern that our health care systems will not be able to meet the costs of this potential increase in the number of patients," Michael Schlander, a health economist at DKFZ, explained.

As an alternative to the two CAR T cell products developed by large pharmaceutical companies, many research institutions, including DKFZ, hope to manufacture the therapeutic cells themselves. For the first time, health economist Schlander, immunologist Stefan Eichmüller and their team of researchers at DKFZ have now listed in detail the costs incurred by an academic institution in producing CAR T cell therapies.

The fixed and variable costs included setting up a clean room, laboratory materials, equipment, and all salaries and non-wage labor costs for the specially trained laboratory staff. As expected, the calculated costs were heavily dependent on the capacity utilization rate of the fully automated production system for the cells. The researchers based their calculations on different scenarios, including a maximum annual capacity utilization rate of the machine with 18 CAR T cell products.



Fully automated production system for CAR T cells
© Eichmüller/DKFZ

Under these conditions, DKFZ could produce a CAR T cell product to treat a patient for less than EUR 60,000. "That would be only about a fifth of the price that the companies charge. And we can cut these costs even further by a considerable amount," Michael Schlander explained, adding that the greatest savings could be made if several of the automated production machines were operated at the same time. An alternative method of transferring the genes for the chimeric receptor could further reduce the production costs to as little as around EUR 33.000 Euro – a tenth of the current commercial price.

Quite apart from these direct savings, the patients would benefit from decentralized CAR T cell production too: "Without the time needed to send the patient's blood and the finished cell therapy, we can provide the treatment within 12 to 14 days – a considerable reduction compared with the three- to four-week waiting time for the commercial products. Patients might then need less chemotherapy and would spend less time in hospital, which would lead to further savings," remarked immunologist Stefan Eichmüller.

The analysis did not take account of the cost of license fees. Michael Schlander and Stefan Eichmüller hope that the present study will also encourage the manufacturing companies to review their current pricing policy for CAR T cell therapies.

Tao Ran, Stefan B. Eichmüller, Patrick Schmidt, Michael Schlander: Cost of decentralized CAR T cell production in an academic non-profit setting.
International Journal of Cancer 2020, DOI: 10.1002/ijc.33156

A photo is available for download: 

Picture caption: DKFZ employees examining CAR T cells under the microscope in a clean room

Note on use of images related to press releases
Use is free of charge. The German Cancer Research Center (Deutsches Krebsforschungszentrum, DKFZ) permits one-time use in the context of reporting about the topic covered in the press release. Images have to be cited as follows: "Source: Eichmüller/DKFZ".
Distribution of images to third parties is not permitted unless prior consent has been obtained from DKFZ's Press Office (phone: ++49-(0)6221 42 2854, E-mail: Any commercial use is prohibited.

With more than 3,000 employees, the German Cancer Research Center (Deutsches Krebsforschungszentrum, DKFZ) is Germany’s largest biomedical research institute. DKFZ scientists identify cancer risk factors, investigate how cancer progresses and develop new cancer prevention strategies. They are also developing new methods to diagnose tumors more precisely and treat cancer patients more successfully. The DKFZ's Cancer Information Service (KID) provides patients, interested citizens and experts with individual answers to questions relating to cancer.

To transfer promising approaches from cancer research to the clinic and thus improve the prognosis of cancer patients, the DKFZ cooperates with excellent research institutions and university hospitals throughout Germany:

  • National Center for Tumor Diseases (NCT, 6 sites)
  • German Cancer Consortium (DKTK, 8 sites)
  • Hopp Children's Cancer Center (KiTZ) Heidelberg
  • Helmholtz Institute for Translational Oncology (HI-TRON Mainz) - A Helmholtz Institute of the DKFZ
  • DKFZ-Hector Cancer Institute at the University Medical Center Mannheim
  • National Cancer Prevention Center (jointly with German Cancer Aid)
The DKFZ is 90 percent financed by the Federal Ministry of Education and Research and 10 percent by the state of Baden-Württemberg. The DKFZ is a member of the Helmholtz Association of German Research Centers.


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