Dissertation title: CAR-T treatments against cancer as a promise and turning point in the French healthcare system
Dissertation under the direction of Maurice Cassier (Cermes3) and Emmanuel Didier (GSPM)
In August 2018, two gene therapies against cancer have received marketing authorization in Europe: Yescartra® by Gilead Sciences and Kymriah® by Novatis. These CAR-T (Chimeric Antigen Receptor) treatments are the firsts of a new generation. The patient’s T lymphocytes are harvested and modified to recognize and attack the cancer cells. Although these treatments only address very specific blood cancers, numerous other clinical trials are being run for other indications, including solid tumors.
These treatments induce major turning points in French healthcare system.
- The first turning point resides in the hope they represent for patients. « The estimated survival rate at 12 months for patients with life-threatening in the very short term diffuse large B-cell lymphoma is 40% for the Kymriah® and 60% for the Yescarta® » says the HAS (Haute Autorité de Santé) about patients without therapeutic alternative. The HAS also takes note of major uncertainties as well as results needing to be confirmed in real life.
- A second turning point rests in the innovative character of these gene therapies whithin the French healthcare system, mainly about the production and manufacturing, conditions of prescription, quality standards and healthcare organisation.
- A third turning point rests in the price itself. These treatments are very costly, between €320.000 and €350.000 per patient. Only a few persons are currently concerned, but new indications on similar treatments might put the French health care system in tension, which could translate into new criteria or new modality for access.
By their novelty and somewhat radical approach, the CAR-T treatments and the promise they represent prove themselves a challenge for healthcare systems, healthcare organisation and society as a whole. This challenge is already a topic, as the marketing authorizations marked the start of the integration and diffusion process in Europe. It is also a future topic, as Yescarta® and Kymriah® are only the firsts of a new generation of gene therapies against cancer.
The thesis project suggests studying the transforming character of these two therapies, and to analyze how they participate in the creation and shaping of a new model for health, care and access in healthcare systems.
