New treatment appears! Can late-stage cancer be cured with 4 million?

Even though it is known as the anti-cancer miracle drug, CAR-T therapy is not perfect. Even though it has brought hope of “cure” to hematological tumors, CAR-T therapy has not made breakthrough progress in solid tumors that account for up to 90%.

The recent emergence of “latecomer” TIL (tumor-infiltrating lymphocyte) therapy is expected to be the first to break this deadlock.

A breakthrough that took 40 years

For a long time, our understanding of diseases and drugs was based on a very simple model.

Even if I am sick, I take medicine, and the medicine will remove the microorganisms in my body, and my illness will be cured.

Scientists and doctors hope to treat cancer through this theory, equate cancer cells with microorganisms, and use various methods such as chemotherapy, radiotherapy, and targeted therapy to completely eliminate cancer cells, and the cancer can be cured.

But reality is obviously not that simple.

Because the current treatment of cancer is a method of “killing one thousand enemies and damaging eight hundred”. Existing treatments cannot be precise enough to attack only cancer cells.

Nowadays, there have been some changes in the scientific community. Everyone thinks that tumor cells do not grow in a vacuum. Tumor cells essentially grow in the human body. Why can’t we use the body’s normal defense mechanism-the immune mechanism to kill these cancers? What about cells?

This change in concept led to the birth of immunotherapy

PD-1/L1 opened a new era of tumor immunotherapy, and then CAR-T therapy took immunotherapy to a new level. This time TIL therapy was finally approved, making doctors exclaim that the “flood” of cancer has finally hit. Higher “dykes”.

The full name of TIL therapy is tumor-infiltrating lymphocyte therapy.

Tumor-infiltrating lymphocytes are immune cells that exist in the tumor microenvironment. Their main function is to identify cancer cells in the body and eliminate them. However, for unknown reasons, the number of these cells suddenly increases in cancer patients. Scarcity or reduced activity ultimately leads to the occurrence of cancer.

How to produce tumor-infiltrating lymphocytes with anti-tumor activity in vitro has become the key to this cell therapy.

Compared with CAR-T therapy, which is from the same school, TIL therapy has attracted more attention. Why?

Although TIL and CAR-T therapy both use immune cells obtained from patients to treat cancer, they have completely different “births”. CAR-T immune cells come from the patient’s blood, while TIL immune cells come from the patient’s tumor tissue. .

This determines the ability of the two to recognize tumors. More than 60% of immune cells isolated from tumor tissue can recognize tumors, while only less than or equal to 0.5% of immune cells isolated from blood.

Some industry analysts believe that TIL therapy solves the problems of solid tumors that are difficult to completely solve with CAR-T and even other cell therapies. It responds to the problem of “lack of targets” with “no specific target” and “comes from the tumor microenvironment” Overcoming “tumor microenvironmental limitations”.

Advanced malignant tumors can also be cured

Cell therapy has finally taken a bite out of the hard bone of solid tumors.

Amtagvi (lifileucel), the first TIL therapy product for solid tumors, was approved for the treatment of advanced melanoma.

According to information released by the FDA, among 73 eligible patients with advanced melanoma, 31.5% achieved remission after use, with 3 cases of tumors disappearing and 20 cases of tumors shrinking.

Among patients who responded to treatment, 43.5% maintained treatment results for at least 12 months, with no tumor progression and no patient death.

Looking at the numbers alone, an effective rate of more than 30% does not seem to be high, but it is different in the field of melanoma where there are not many good treatments. Before this, the overall response rate of first-line mainstream drug treatment was only about 20%. .

It is worth noting that the patients included in this study have undergone a variety of treatments. Patients with incurable advanced melanoma generally only have seven or eight months left to live. Such a treatment effect is already Survival from desperate situation.

Moreover, some patients’ treatment effects have been maintained for more than 4 years. The industry believes that this shows that the effect of Amtagvi lasts longer, which is also one of the advantages of the drug.

In addition, TIL therapy is currently undergoing clinical trials for non-small cell lung cancer, ovarian cancer, head and neck cancer, cervical cancer, etc. Judging from the known information, TIL therapy is currently targeting non-small cell lung cancer, ovarian cancer, head and neck cancer, and cervical cancer. Very good results have been achieved in patients with small cell lung cancer, which is worth looking forward to.

These results point to the fact that the use of this type of therapy may continue to write the “Emily-style” miracle in the field of solid tumors (currently melanoma) (Emily suffered from leukemia and used CART for treatment, scientists They were surprised to find that the previous cancer cells disappeared, and the leukemia was truly cured).

Who can pay for the high cost of immunotherapy?

After the emergence of CART therapy, the most intuitive feeling for tumor immune cell therapy is that it is expensive. Taking the domestically marketed CAR-T drugs Akilenza Injection and Regiolonza Injection as examples, one injection costs up to 1.2 million yuan. .

TIL therapy is even more expensive. 39 Deep Breath learned that the current prerequisite for using TIL therapy requires patients to first undergo tumor resection surgery. In other words, the use of TIL therapy requires that the tumor must be resectable, and sufficient amount must be obtained from the resection sample. TIL.

After surgically obtaining an active sample with sufficient TIL, it takes approximately 34 days to prepare. Patients also need to be pretreated with lymphocyte depletion and then re-infused with TIL. At the same time, patients also need to continuously inject large doses of IL-2 to continue to maintain cell activity, but large doses of IL-2 itself are biologically toxic.

 

It is understood that Amtagvi, which is currently on the market, is priced at US$515,000 (3.7 million yuan) and does not include the cost of IL-2, which is an important part that must be used simultaneously with TIL therapy. The cost of a single dose of IL-2 It is US$5,855 (40,000 RMB).

In other words, the total cost of TIL therapy + IL-2 is approximately RMB 3.74 million.

Without medical insurance and national-level policy support, this therapy is far beyond the reach of ordinary people.

In addition, TIL has some unique problems that need to be solved. For example, there must be immune cells inside the tumor. Secondly, high-dose chemotherapy must be performed before TIL treatment. It is still unknown whether the patient’s body can bear the burden. “TIL therapy is a new treatment and a new hope, but the production process is complex, the price is too high, and future accessibility is low.” said a senior person in the pharmaceutical industry.

But at present, the hope of cure has been ignited, holding the last line of defense against cancer, making more pharmaceutical companies willing to invest in research and development. According us , at least 14 pharmaceutical companies in China are developing TIL therapies for solid tumors.

But for more experts, any treatment for cancer is far less effective than early prevention.

In hopes of curing cancer with drugs, oncologists say early detection and early diagnosis are more cost-effective.