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What’s the difference between commercial CAR-T therapy and the cancer treatments that have come before it? The same things, said Lineberger researcher Dr. Gianpietro Dotti, that separate fine dining from a mass-produced meal in a box.

Personalization … and price.

“You have a restaurant, and every day you make a separate meal for each guest,” he said. “With CAR-T, it’s the same. You make the cells for a specific person. It’s a live product that you need to make all the time.”

The sticker prices for a single infusion of Kymriah ($475,000) and Yescarta ($373,000), which treat blood cancers and are the only FDA-approved CAR-T therapies on the market, have raised caution flags about the treatment’s sustainability. A 2019 Reuters report described how hospitals that still lack coverage agreements with insurers for commercial CAR-Ts sometimes refer their lymphoma patients to clinical trials instead.

And as researchers at UNC and elsewhere discover CAR-T therapies that can defeat more common cancers of the lung, prostate and breast, that price point — which does not include follow-up care — would burst an already swollen health care system, with Medicare and insurance companies scrambling to cover CAR-T for more patients.

“We have to get through the science first,” said UNC Lineberger Comprehensive Cancer Center chief Dr. Shelley Earp ’70 (MD, ’72 MS). But when more cancers become treatable with CAR-T, he said, UNC won’t be idle as the market inches toward a sustainable model. He envisions Lineberger becoming a CAR-T treatment center for all patients, not just those on clinical trials.

“Commercialization would be desirable across the country, but that may take a long time in solid tumors,” Earp said. “If we’re successful in doing this, we want to be able to scale it so that we have a larger capacity to treat people here at UNC.”