How can we harness the potential of cell and gene therapy for all?
Each year, there will be 23.6 million new cases of cancer worldwide by 2030, according to the World Health Organization (WHO).
The International Agency for Research on Cancer estimates there will be 27.5 million new cancer cases and 16.3 million cancer deaths worldwide by 2040, up from 17 million new cancer cases and 9.5 million cancer deaths in 2018. The World Health Organization (WHO) attributes an anticipated rise in cancer cases to people living longer; growing exposure to risk factors, especially in low- and middle-income countries; and an expected increased incidence among younger people.
While we haven’t yet won the war on cancer, we are winning some battles. Over the past 30-plus years, survival rates have doubled and people are living longer with cancer than ever before. Novel treatments are helping patients delay the worsening of their disease or lower the chance of recurrence, while improving their overall quality of life.
On the scientific front, we are witnessing what experts are calling a “golden age” of cancer research and discovery. We know that cancer is not one, but many diseases – more than 200 in fact. And our knowledge and management of those diseases is increasing at a rapid pace.
Some of the most exciting, life-changing possibilities for patients with cancer and other serious illnesses are in cell and gene therapies (CGT). Cell therapy aims to treat disease by restoring or altering certain sets of cells or by using cells to carry a therapy through the body. Gene therapy replaces, inactivates, or introduces genes into cells. Therapies that are considered both cell and gene therapies alter genes in specific types of cells and insert them into the body.
A mother who spends hours each day hooked up to an artificial kidney machine has a chance for a normal life.
A father who’s lost his sight has the chance to see again.
A son dying from cancer has the chance of a cure.
Health outcomes that were once unimaginable are now within reach.
“Individualized therapies can dramatically improve outcomes in cancer and alleviate the burden of these catastrophic diseases,” says Pamela Spence, EY Global Health Sciences and Wellness Industry Leader. “This is not just a game changer for cancer care but has the potential for application in a number of other very debilitating diseases.”
Gene therapy has been a work in progress for almost 40 years, but it is now experiencing an acceleration. In 2017, the U.S. Food and Drug Administration (FDA) approved the first gene therapy treatments. While 2019 only saw one approval, the agency expects to see a doubling of new gene therapy applications every year. Scott Gottlieb, the former FDA commissioner, predicted that by the year 2025, the US will be approving between 10 and 20 different gene therapies every year.
However, the evolving cancer treatment paradigm from a mass market (1-for-Many) to an individualized (N of 1) poses significant challenges that will multiply as CGT options and their usage increase.
“These treatments use the patient’s own blood or tissue, which is transformed into a personalized therapy and then reinfused. There is no room for error – the system must deliver the right drug for the right patient at the right time and right place, every time,” says Adlai Goldberg, EY Global Digital, Social and Commercial Innovation Life Sciences Leader.
In addition to being difficult to create and administer, cell and gene therapies are also very expensive and only available to a handful of people. EY examined how it could help transform the treatment of oncological and other serious diseases by enabling highly effective, efficient and safe delivery of individualized therapies at commercial scale.
The operational requirements for individualized care
The only way to make cell and gene therapies a reality at scale is to create an ecosystem of different stakeholders working together and sharing data and information they all trust. This includes patients, health care providers, health services companies, insurers/payers, and the biopharmaceutical industry. No single player – regardless of how smart or well-funded – can do this alone.
“Truly individualized care requires you have an error-free outcome from beginning to end. It means you need a fail-safe value chain with far better transparency and a real time understanding of what's going on with every individual patient throughout the course of their therapy at any point in time. And since patients are already quite ill, it needs to take as little time as possible,” says Karl Roberts, EY Managing Director, Strategy & Operations, Strategy and Transactions. “How did EY approach this challenge? By asking the right questions.”