Novartis focusing on cutting CAR-T costs ahead of EU launches

The Swiss pharma is busy launching its chimeric antigen receptor T-cell (CAR-T) therapy Kymriah (tisagenlecleucel) across Europe, and is finding ways to bring the therapy to certain patients with advanced leukaemia.

Liz Barrett, CEO of Novartis Oncology, told the Economist War on Cancer conference in London that the firm is making substantial investments in infrastructure to bring the costly therapy to patients, focusing initially on its approved use in children and young people with acute lymphoblastic leukaemia.

CAR-Ts are powerful and potentially curative one-off therapies made by harvesting a patient’s own T-cells, genetically modifying them to attack cancer, and then re-injecting back into the patient.

It’s a costly and time-consuming process and the Swiss firm is looking at ways to make it more efficient after issues getting the therapy to hospitals and patients in the US where it was first approved.

At the moment the company relies on larger hubs to manufacture the cells, transporting them to and from various clinics in the countries where the treatment is available.

But Barrett told pharmaphorum that Novartis is looking to move manufacturing facilities closer to the clinics where patients are treated to speed up the process.

She said: "We are trying to build new technology to disrupt manufacturing so that we can deliver (the cells) more efficiently."

Barrett added that Novartis is keeping a watching brief on ‘off-the-shelf’, or allogeneic, therapies to see if they are a viable alternative to CAR-Ts.

Companies such as Allogene, along with its partner Cellectis, are trying to develop cancer cell therapies that are derived from a bank of cells that will not require the expensive electrophoresis procedure.

Liz Barrett

For now, Barrett said Novartis is waiting to see whether allogeneic therapies can produce results that are in line with already approved CAR-Ts.

Issues that currently need to be addressed are the number of cells neeeded to produce a strong enough response rate, said Barrett.

But she added that the network of clinics that Novartis is building with health systems across Europe will be able to deliver a "broad portfolio" of cancer cell therapies in the future.

Building capacity in Europe

The UK was the first country in Europe to bring CAR-T therapies to patients, and the NHS announced last week that Kymriah is available to patients via the Cancer Drugs Fund in England.

Novartis is now in talks with other countries in the EU, and Emanuele Ostuni, Novartis’ head of cell and gene therapy in Europe told pharmaphorum that talks with payers had been "constructive" and that clinics are keen to bring the therapy to patients.

In the UK Kymriah costs £282,000 for a single dose at list price, but according to Ostuni payers can see the value of  Kymriah once they realise it can provide benefits to patients in the long term.

Novartis is working with payers across Europe on a case-by-case basis to secure access, he said.

He added that the talks are paving the way for other cell therapies in the future, as health systems gear up to provide drugs that can have a large impact on a small group of patients.

Ostuni told pharmaphorum: "Budget impact is generally very small, it’s creating a sandbox for experimentation. Many payers are looking at this to experiment with what they will do in the future."

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