Do it yourself
One of the most promising treatments for blood cancer involves reengineering immune cells to attack cancer cells. CAR-T, or chimeric antigen receptor T-cell therapy, takes cells drawn from a patient’s blood, adds a receptor gene in a lab and then reinjects the cells into the patient. A report by the American Society of Hematology found that after CAR-T treatment, three-quarters of blood cancer patients achieved remission.
The therapy, first approved in the US in 2017, typically costs more than $350,000.
Brazil has both a public health system and a private one, and CAR-T is currently offered only through the private one, with its maximum prices defined by the Brazilian Chamber of Drug Market Regulation. The drugs Kymriah, from Novartis, and Yescarta, from Gilead/Kite, can cost up to 2.2 million reais ($440,000), according to the Chamber. Carvykti, from Janssen-Cilag, has a maximum authorized price of 3.2 million reais.
So last month, Fiocruz, a research foundation under the Brazilian Ministry of Health, and Caring Cross, a nonprofit working to accelerate development of advanced medicines, announced a collaboration to develop local production of CAR-T treatments. Boro Dropulić, executive director of Caring Cross, says this is expected to bring the cost down to $35,000 per dose in Brazil.
Dropulić attributes the significant cost savings to the nation’s lower labor costs and a Fiocruz workforce that’s already proven itself adept at technology transfer. During the pandemic, for instance, the foundation partnered with AstraZeneca to locally produce the Covid vaccine that was widely used in Brazil.
The Fiocruz-Caring Cross CAR-T therapies will initially be focused on leukemia and lymphoma. Fiocruz estimates that 2,000 people could be treated during clinical trials, which are expected to begin by early 2025, according to Dropulić.
If the technology was imported from the US, it would cost at least $700 million to treat those 2,000 people, Fiocruz says, but local CAR-T production means the costs will likely be one-tenth of that — a huge savings for the government, which provides free medical care for all.
After clinical trials end, CAR-T treatments are expected to become widely available in Brazil, the National Cancer Institute says. Fiocruz says that while its initial focus for Brazil’s CAR-T output is its own citizens, use of this cheaper gene therapy in other Latin American countries is being discussed.
Scientists also hope CAR-T therapy may one day be used to treat other diseases, such as HIV. — Gabriel Tavares
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