If decades of research and tens of billions of dollars in investment have taught us one thing about cancer, it’s the science of detecting and cheating the disease. Drugs that ace this are among the highest grossers for their manufacturers.
“If you start with 1 billion cells, there are 1 billion routes to resist [the treatment], if you start with 100 cells, there are 100 routes to resist [the treatment]. So detecting early and cheating early has been successful,” says Siddhartha Mukherjee, assistant professor at Columbia University in the United States. As an oncologist and translational researcher, Mukherjee has seen that success, especially with the blockbuster breast cancer drug trastuzumab. Now, he wants to push the boundaries with the newest tech on the block—CAR-T cell therapy. Debatably placed between a pharmaceutical product and a procedure, it uses a patient’s own immune cells to fight cancer.
Ever since the first product Kymriah, from Swiss pharma major Novartis, meant for ALL—a type of blood cancer—hit the market in 2017, people have marvelled at the technology. Equally, they’ve baulked at the price—$475,000. Gilead’s Yescarta is slightly cheaper at $373,000.
Both Novartis and Gilead have filed patents in India. But before they figure out differential pricing or even make up their mind about offering this extremely complex therapy in India, a fledgeling startup is counting CAR-T cells.
Less than a year old, Immuneel has a formidable founding team: Biocon founder and chairperson Kiran Mazumdar-Shaw, Boston-based 5AM Ventures founder and life-sciences professional Kush Parmar, and Mukherjee, who has founded four other cancer therapeutics companies. Six months ago, on a lark, the team raised $15 million in venture philanthropy from some healthcare czars and venture capitalists, including Khosla Ventures in California.
For the longest while, believes Parmar, complex cancer therapies have focused on the developed world. The discrepancy, therefore, between what is available in the West and what is available in India is glaring. A cross-border company bringing US technologies to India to become viable and better was never the model. “We have the inverse; take phenomenal technologies from the US, where they face a very crowded market. And because these are life-threatening disorders, not rare diseases, the new tech becomes possible and viable in India,” Parmar says. At a fraction of the prevailing price—$50,000—Immuneel intends to shake things up, not just CAR-Ts.
The West is debating whether to bring cell therapy from last-ditch to front line. Whether to continue leading with ineffective chemotherapy only to land at cell therapy later, or whether to swap the last-ditch and frontline, add combination therapies in between and change the universe of cancer care for good. After all, the first patient to have received CART-T at the University of Pennsylvania in 2010 remains cancer-free till date.
Developed countries, however, are restricted by their own complex regulatory and payer environment.