Medicine Nobel for immunotherapy should put focus on this.
Immunotherapy as a possible cure for some forms of cancer has come a long way from the 1980s, when most firms and researchers abandoned the field. The Nobel for physiology/medicine this year recognises two researchers—James Allison of the University of Texas and Tasuku Honjo of the University of Kyoto—who persevered against naysayers to discover cancer therapy by “inhibition of negative immune regulation”.
In 1994, Allison, who was then at the University of California, Berkeley, reported that CTLA-4, a protein present on T-cells, derailed the immune system’s assault on cancer cells by acting as a brake. Following this discovery, he developed an antibody that blocks CTLA-4 and, thus, allows the immune system to attack cancer cells.
On the other side of the Pacific, Honjo, who was working on cancer immunotherapy since 1992, discovered another protein, PD-1, that acted as a brake for the immune system in taking on cancer. When the gene that codes for PD-1 was inactivated, it led to autoimmune disorders. Honjo, thus, worked on blocking the protein’s action.
Allison’s and Honjo’s research helped establish the role of immune system “checkpoints” in the body’s ability to fight cancer, and cancer immunotherapy has grown from strength to strength since. That offers significant hope since other treatment lines, particularly chemotherapy and radiotherapy, attack cancer, but healthy cells become the collateral the body pays. In comparison, immunotherapy is much more targetted and can fight off late-stage cancer in some cases.
The advances in cancer cure are amazing, but their costs put them out of reach for most—Peter Bach at the Memorial Sloan Kettering Cancer Center, a top cancer research institute, says that cancer drug prices rose 100 times (inflation-adjusted) since 1965, and “the cost of an additional year of life from a cancer treatment increases by $8,500 each year”.
Immunotherapies in the US, as per a Vox report, cost more than $100,000 per patient. While drug development is no doubt expensive—Novartis says developing the immunotherapy drug, Kymriah, cost $1 billion—Ezekiel Emanuel, a professor at University of Pennsylvania’s (UPenn’s) Perelman School of Medicine writes in The Wall Street Journal that, based on Kymriah’s list price, it would take just 2,700 patients for Novartis to recoup its entire R&D expenditure.
Even if the significant discounts for some patients are factored in, Emanuel argues that recovery of the R&D expenditure shouldn’t need too many treatments. UPenn research further estimates the costs of removing, reprogramming and infusing the cells under this form of immunotherapy could be just a sixth of its list price.
What this argument doesn’t consider is that the form of cancer a Kymriah treats may not be common—the incidence rate for non-Hodgkin’s lymphoma, a cancer-form treated by Kymriah, in the US is 37.7 per 100,000 people—and the pool of patients who can afford the treatment could be even smaller. Thus, even R&D-cost recovery could take long. However, cancer cure, including immunotherapies, must be made more accessible—in India, over 40% of patients drop out of treatment due to high costs, though the costs are much lower compared to similar treatment in, say, the US. Allison’s and Honjo’s Nobel win should, hopefully, draw attention to that.