Latest / CareTalk: Healthcare. Unfiltered. / Delivering on the Promise of CAR T Cell Therapy w/ Dr. Jason Bock

Transcript

Delivering on the Promise of CAR T Cell Therapy w/ Dr. Jason Bock · CareTalk: Healthcare. Unfiltered.

• 0:00
  David: The future of cancer treatment is on the horizon, but can we afford it, regulate it, and deliver it at scale.
• 0:13
  David: Hi everyone.
• 0:14
  David: I'm David Williams, president of Strategy consulting firm, health Business Group, and host of the Health Biz Podcast, where I interview top healthcare leaders about their lives and careers.
• 0:24
  David: My guest today is Dr. Jason Bock.
• 0:25
  David: He's co-founder and CEO of CTMC, a joint venture between National Re Resilience and MD Anderson Cancer Center, which accelerates development and manufacturing of innovative cell therapies to cure cancer.
• 0:38
  David: Do you like this show?
• 0:39
  David: If so, please subscribe and leave a review.
• 0:42
  David: Jason, welcome to the Health Biz Podcast.
• 0:45
  Dr. Jason Bock: Thanks so much for having me on, David.
• 0:46
  Dr. Jason Bock: Looking forward to the discussion.
• 0:48
  David: You know, usually we sometimes say, you know, this isn't rocket science, or we're not trying to cure cancer here, but, but we are at least the latter.
• 0:54
  David: So, uh, you know, no, no expectations, but let's, uh, let's jump in.
• 0:59
  David: So cell and gene therapies, you know, very exciting.
• 1:02
  David: They hold huge promise, and I wonder to what extent has that promise been realized in cancer care?
• 1:09
  Dr. Jason Bock: Yeah.
• 1:11
  Dr. Jason Bock: So first let's distinguish cell and gene therapy, even though they get lumped together, CGT or cell and gene.
• 1:17
  Dr. Jason Bock: It's sort of like these words get linked together, but really they're distinct therapeutic modalities.
• 1:22
  Dr. Jason Bock: And so cell therapy is where we take a patient's own, uh, typically immune cells, uh, and for autologous cell therapy, we take them out of their body, do the engineering in our manufacturing facility, and then we turn them to the same patient.
• 1:39
  Dr. Jason Bock: There's a lot of different flavors of that, but that's the most prevalent one right now, and commercially, uh, available.
• 1:47
  Dr. Jason Bock: And, and so
• 1:48
  David: the autologous refers to the auto being
• 1:51
  Dr. Jason Bock: self.
• 1:51
  David: The self.
• 1:51
  Dr. Jason Bock: Yep.
• 1:53
  Dr. Jason Bock: And so, you know, if you, if you zoom out, what if's happening, uh, when a patient gets cancer, is.
• 2:01
  Dr. Jason Bock: You know, over time some cells accumulate a series of mutations and figure out a way to avoid the immune system.
• 2:09
  Dr. Jason Bock: The immune system is constantly looking for these cells and pruning them back.
• 2:13
  Dr. Jason Bock: But unfortunately, occasionally the cancer cells went out and get a little out of control.
• 2:18
  Dr. Jason Bock: That's when you're actually have cancer.
• 2:22
  Dr. Jason Bock: And what we're really trying to do in many ways is a very, um.
• 2:28
  Dr. Jason Bock: Holistic and um, um, you know, almost like natural way of reestablishing that equilibrium.
• 2:38
  Dr. Jason Bock: So we're taking these cells from a patient's body that normally are surveilling for cancer and amping them up with some engineer.
• 2:48
  Dr. Jason Bock: To go back into that very same person and reestablish that equilibrium.
• 2:53
  Dr. Jason Bock: And what we call that, you know, this fancy term equilibrium is essentially trying to cure cancer and get these patients healthy again.
• 3:01
  David: Nice.
• 3:01
  David: So it's great concept and it's good to, you know, distinguish between just to take CGT and say, you know, cell therapy, let's focus on that.
• 3:10
  David: Are we there yet?
• 3:11
  David: Is it happening?
• 3:13
  Dr. Jason Bock: You know, it's always a journey, not a destination.
• 3:16
  Dr. Jason Bock: You know, in terms of treating cancer, um, we, you know, it's not a monolithic disease.
• 3:23
  Dr. Jason Bock: There's a lot of different aspects of it, but what's amazing is the progress we've made in cell therapy over say the last seven or eight years, and I think.
• 3:34
  Dr. Jason Bock: Uh, because the pro, the initial, uh, progress was so amazing that the, the expectations are sky high for cell therapy.
• 3:43
  Dr. Jason Bock: I love that.
• 3:44
  Dr. Jason Bock: 'cause we should have these high aspirations.
• 3:47
  Dr. Jason Bock: Um, you know, one of the ways these, if I can, one of the ways these aspirations were set was, um, one of the first patients, actually the first pediatric patient treated with a CD 19 CAR T. Uh, is, has become literally the poster child for the industry.
• 4:05
  Dr. Jason Bock: Her name is Emily Whitehead.
• 4:07
  Dr. Jason Bock: When she was six years old, five, six years old, uh, she was diagnosed with childhood leukemia.
• 4:14
  Dr. Jason Bock: Uh, and unfortunately all available treatments failed to, uh, halt her cancer.
• 4:22
  Dr. Jason Bock: And so at, uh, after a few years of trying these available treatments, her parents were basically told, take her home.
• 4:30
  Dr. Jason Bock: Here's the number for hospice and just enjoy the short time you have left with her three to six months.
• 4:38
  Dr. Jason Bock: Luckily, her parents didn't give up and found us, uh, that a new clinical trial had just opened for CAR T cells, uh, just two weeks before this.
• 4:51
  Dr. Jason Bock: And so she was enrolled as the first patient.
• 4:54
  Dr. Jason Bock: They, uh, removed her.
• 4:57
  Dr. Jason Bock: Some of her t cells engineered those in the lab, re-infused those, took her.
• 5:02
  Dr. Jason Bock: She had a very severe reaction to those cells.
• 5:05
  Dr. Jason Bock: Actually went into a coma and was near death.
• 5:10
  Dr. Jason Bock: Um, but then, uh, quite a lot of fight in that little girl.
• 5:15
  Dr. Jason Bock: She came out of the coma and David.
• 5:20
  Dr. Jason Bock: 30 days later, they scanned her for cancer.
• 5:25
  Dr. Jason Bock: And where before the treatment, her body was essentially riddled with cancer.
• 5:30
  Dr. Jason Bock: Um, at that first scan, it was undetectable and that, that treatment that she had been given, she's never gotten another treatment for cancer since then, 12 years later, she's, uh, undergraduate at University of Pennsylvania.
• 5:50
  Dr. Jason Bock: Has never gotten another treatment for cancer and has her whole life in front of her.
• 5:54
  David: So is the nature of, you know, in, in a lot of fields, the progress tends to be incremental.
• 5:59
  David: If have a car, it gets a little bit better.
• 6:01
  David: Gas mileage, it's like a little lower drag, you know, coefficient, et cetera.
• 6:05
  David: And in cancer sometimes it's like that too.
• 6:07
  David: But with cell therapy is the nature of it that you have some patients that had.
• 6:13
  David: So you're saying they're on the verge of hospice or in hospice and can be cured and they might, you know, they're not even a cancer patient after that?
• 6:20
  David: Or is there more of this sort of incremental progress?
• 6:22
  David: How do we think about it?
• 6:23
  David: Yeah,
• 6:24
  Dr. Jason Bock: you know what differentiates immunotherapy in general?
• 6:28
  Dr. Jason Bock: Immunotherapy being where we utilize the body's immune system to fight cancer rather than.
• 6:36
  Dr. Jason Bock: Sort of directly trying to poison the cancer with something like chemotherapy or radiation.
• 6:41
  Dr. Jason Bock: So with what distinguishes immunotherapy is, um, if you look at the response rate, um, there's, you know, an initial response.
• 6:53
  Dr. Jason Bock: There's some patients who over the first.
• 6:56
  Dr. Jason Bock: 3, 6, 9 months.
• 6:58
  Dr. Jason Bock: Uh, the, the treatment does fail, but then what's the sign signature of immunotherapy is what?
• 7:04
  Dr. Jason Bock: There's this very long tail of patients who are, are long-term responders because you've essentially trained the immune system.
• 7:13
  Dr. Jason Bock: It's still there.
• 7:14
  Dr. Jason Bock: It's still surveilling and reestablishing that equilibrium with the body not having cancer anymore.
• 7:22
  Dr. Jason Bock: And so that's what CAR T being the most advanced kind of immunotherapy is able to do.
• 7:29
  Dr. Jason Bock: And, uh, not everyone is cured.
• 7:32
  Dr. Jason Bock: Unfortunately, we're working on getting those response rates up, but there's a very high fraction of patients who are essentially cured and don't need another treatment.
• 7:41
  Dr. Jason Bock: And this is with a single dose, uh, therapy.
• 7:45
  Dr. Jason Bock: That's what's really transformative about cell therapy is.
• 7:50
  Dr. Jason Bock: Single dose treatments with curative intent.
• 7:54
  Dr. Jason Bock: There's a lot of other cancer treatments which do, um, improve what's called progression-free survival.
• 8:01
  Dr. Jason Bock: So patients, you know, um, have three more months before their cancer, uh, improves, or six more months, nine more months, hopefully as long as possible.
• 8:12
  Dr. Jason Bock: Um, but with cell therapy, um, there's a large fraction of patients who are long-term responders.
• 8:21
  David: So as we look at the, uh, trajectory here, is it basically finding ways that CAR T can apply to more patients and that, uh, we have more of those success stories, like the, uh, the Whitehead example that you just gave, or there's some new technologies that come along, either other forms of immunotherapy or changes within cell therapy itself.
• 8:42
  David: What, what do you see happening?
• 8:45
  Dr. Jason Bock: So much.
• 8:46
  Dr. Jason Bock: All of the above really.
• 8:47
  Dr. Jason Bock: We, so that that first generation of treatments targeted a specific antigen CD 19 present on B cells.
• 8:55
  Dr. Jason Bock: And so where we've made the most progress with cell therapies is in the treatment of, uh, B-cell, uh, leukemias and lymphomas.
• 9:04
  Dr. Jason Bock: And that's been transformative.
• 9:07
  Dr. Jason Bock: Um, that if you go to the major cancer, uh, hematologic cancer conferences, all of the exciting discussions are about CAR T and it's established as a transformational, uh, treatment.
• 9:20
  Dr. Jason Bock: There, it's changed the treatment landscape.
• 9:23
  Dr. Jason Bock: Now there will be incremental improvements in that we are, and the field is working on moving, uh, CAR T to earlier lines of treatment.
• 9:34
  Dr. Jason Bock: As well as expanding the number of cancers it works on.
• 9:39
  Dr. Jason Bock: Um, uh, so, uh, there's been a lot of excitement over the last few years in a different antigen than than CD 19, um, uh, BCMA that targets a cancer called multiple myeloma.
• 9:56
  Dr. Jason Bock: And have seen remarkable progress in that.
• 9:59
  Dr. Jason Bock: Um, and that treatment has shown efficacy as early as second line and is moving even to, uh, first line.
• 10:06
  Dr. Jason Bock: Um, so there will be those expansions, uh, moving treatment to earlier lines, expanding the number of cancers.
• 10:14
  Dr. Jason Bock: Um, I think in general though, the big step we're trying to make is moving this from the blood cancers.
• 10:24
  Dr. Jason Bock: Two solid tumors and solid tumors represent about 90% of all cancer cases.
• 10:30
  Dr. Jason Bock: So we've had this transformation go on in hematologic malignancies, that's about 10%.
• 10:36
  Dr. Jason Bock: And so moving the cell therapies to trying to treat, uh, solid tumors is, I think the, the big next step.
• 10:45
  David: Got it.
• 10:45
  David: Alright, so let's say you, you know, managed to get into solid tumors and have the supply to like a large percentage of, of cancer patients.
• 10:54
  David: Then.
• 10:54
  David: So let's just say, you know, wave it.
• 10:55
  David: I've studied economics.
• 10:56
  David: I say assume that you don't,
• 10:58
  Dr. Jason Bock: that wand, assume that
• 10:59
  David: part of it.
• 10:59
  David: Yeah.
• 11:00
  David: Someone said to me, if you had a magic wand that's, I do have a magic wand, so then I'm just gonna decide to wave it.
• 11:05
  David: So I'll wave it and say solid cancers, you know, can also be addressed this way and now.
• 11:12
  David: What's the challenge?
• 11:12
  David: So I could imagine, you know, anything you do in, in med in general, but in medicine in particular, you do small scale.
• 11:19
  David: Like a lot of these cell therapies might have originally been, you know, in one particular physician's, you know, lab or one place in the world, you could go and do it and then you try to scale it up, make a company out of it, and so on.
• 11:28
  David: That's hard enough.
• 11:29
  David: But what if you've got a generally, um, applicable technology, then what, how are we gonna change the whole cancer, uh, ecosystem in the country?
• 11:41
  Dr. Jason Bock: Yeah, I mean, that's a great, great question and I hope that's a, that's a, a problem in the challenge we get to tackle.
• 11:48
  Dr. Jason Bock: I think there's a lot of technical and scientific and biologic challenges with applying cell therapy to solid tumors.
• 11:57
  Dr. Jason Bock: I think there's been a lot of, uh, progress made in just the last year or two in that regard.
• 12:04
  Dr. Jason Bock: Still, uh, you know, it'll be a big spell when you wave that wand to make that happen.
• 12:09
  Dr. Jason Bock: Um, but we're making progress there.
• 12:12
  Dr. Jason Bock: Um, you know, I, and I, I, I, I think we shouldn't underestimate, when I use the word transformational, it's a whole different way of a healthcare system because if you look at cancer.
• 12:31
  Dr. Jason Bock: Um, it's, you know, for the most part, treated as a chronic disease.
• 12:36
  Dr. Jason Bock: You have to come back, you have cycles of chemotherapy or different radiation cycles, and you are basically constantly in and out of the hospital or getting different treatments and things.
• 12:47
  Dr. Jason Bock: And with cell therapy, while it's very intense, it's about a two week treatment cycle.
• 12:53
  Dr. Jason Bock: And then if it works, you're done and you have your life, uh, back.
• 12:59
  Dr. Jason Bock: Emily just goes in for a scan every once in a while.
• 13:02
  Dr. Jason Bock: She's not taking any maintenance treatments or anything like that.
• 13:06
  Dr. Jason Bock: Um, so that kind of transformation, um, uh, affects all aspects of the healthcare system.
• 13:15
  Dr. Jason Bock: How, how we.
• 13:18
  Dr. Jason Bock: Um, you know, set up systems for one, one time treatments, how we cover those from the financial and, uh, you know, insurance, uh, systems as well as, you know, what we focus on a lot is how we manufacture and, and scale those.
• 13:35
  Dr. Jason Bock: So happy to talk about any one of those aspects.
• 13:38
  David: Well, let's talk about, I think it's probably the most relevant one is sort of manufacturing scale, but, so I'm gonna go in the other direction.
• 13:44
  David: Okay.
• 13:44
  David: And talk about something I know a little bit more about.
• 13:46
  David: So in Boston where I live, you've got Dana-Farber Cancer Institute.
• 13:50
  David: Yeah.
• 13:50
  David: And they have been affiliated for a long time with Brigham and Women's Hospital, now part of MGB, et cetera.
• 13:56
  David: And they broke off and are going to the bi It's a lot of local stuff happening.
• 14:00
  David: Yeah.
• 14:00
  David: But, but the, but one interesting factor there is that, um, one reason that the Brigham didn't want to have this happen is that, uh, 45% of their surgeries are cancer surgeries.
• 14:13
  David: Hmm.
• 14:13
  David: And so it's a gigantic, um, you know, amount of activity and.
• 14:19
  David: You know, revenue or expense, depending on how you look at it.
• 14:22
  David: Now, I know, you know, cell therapy, one of the challenges, you, you hear the price tag for, you know, wow, that's, that's expensive.
• 14:27
  David: But how do the overall economics look?
• 14:30
  David: If you, if you, if my wand has been, you know, waived in the magical spell, uh, set and say, let's actually go and say it is this two weeks.
• 14:39
  David: You don't have necessarily surgery, maybe we don't have proton beam, we don't have a, like a lot of infrastructure, um, right.
• 14:47
  David: How, what's the overall, you know, structure look like and what's the, even, even the cost?
• 14:52
  Dr. Jason Bock: Yeah.
• 14:53
  Dr. Jason Bock: So let me, you know, there was a real, so, um.
• 14:57
  Dr. Jason Bock: ASCO is a big, uh, oncology conference every year, uh, where all the oncology research and leaders get together and, and discuss.
• 15:06
  Dr. Jason Bock: So there was a really interesting interview by the CEO, uh, given by the CEO of Legend Pharmaceuticals, which is one of the makers of, uh, uh, uh, CAR T treatment, uh, for multiple myeloma.
• 15:22
  Dr. Jason Bock: And he got asked about the cost.
• 15:24
  Dr. Jason Bock: And so they had done this study.
• 15:27
  Dr. Jason Bock: Where they ha were trying to move the, the product they make is called Victi.
• 15:32
  Dr. Jason Bock: They were trying to move victi from later line treatment to second line treatment.
• 15:36
  Dr. Jason Bock: And I think I'm getting all the details right of his interview.
• 15:39
  Dr. Jason Bock: Um, and so to do that, they had an active control arm in that study, which was basically, it's the, the colloquial term is dealer's choice.
• 15:48
  Dr. Jason Bock: It basically means that clinician can give any treatment they want to the patient.
• 15:54
  Dr. Jason Bock: The best available, you know, current commercial treatments.
• 15:57
  Dr. Jason Bock: And then the, um, active arm will be given the cell therapy victi.
• 16:03
  Dr. Jason Bock: And so they had this two arm study with about 80 patients in each arm, so a pretty good number of patients.
• 16:09
  Dr. Jason Bock: And then they followed the patients for two years.
• 16:12
  Dr. Jason Bock: And so from an efficacy and safety point of view, the victi arm outperformed standard of care.
• 16:20
  Dr. Jason Bock: Okay, but, but your question was about cost.
• 16:23
  Dr. Jason Bock: What's interesting in that study, they were able to look at basically costs in a controlled way.
• 16:29
  Dr. Jason Bock: Um, because it was in a, in a clinical study and for the Victi arm, all in costs for the treatment, for subsequent doctor's visits, hospitalizations, whatever.
• 16:42
  Dr. Jason Bock: All in cost over two years was around $700,000.
• 16:48
  Dr. Jason Bock: Okay.
• 16:49
  Dr. Jason Bock: A lot of money.
• 16:50
  Dr. Jason Bock: Um, but these are, you know, pretty sick cancer patients for the sort of standard of care arm.
• 16:58
  Dr. Jason Bock: Um, it was 1.3 million and so dramatically more expensive that accrued over those two years.
• 17:12
  Dr. Jason Bock: And so I think that hopefully that example shows that.
• 17:17
  Dr. Jason Bock: Cost effect, the overall cost effectiveness of a single dose treatment.
• 17:22
  Dr. Jason Bock: Now, you know, uh, you know, we can look at exactly for that standard of care and where those costs are distributed.
• 17:30
  Dr. Jason Bock: Just as you were saying, some of it's from the pharmacy, some of it's from radiology doing more scans.
• 17:35
  Dr. Jason Bock: Some of it's from hospitalization, some of it is from other drugs that they were prescribed and things.
• 17:42
  Dr. Jason Bock: Whereas in the, um, cell therapy arm, most of it was for that one-time therapy upfront.
• 17:49
  Dr. Jason Bock: And so, you know, understanding that shift, um, will be disruptive.
• 17:57
  Dr. Jason Bock: Um, and I think part of.
• 18:01
  Dr. Jason Bock: The challenge of getting cell therapies more widely accessible to patients is, is, is some of that disruption?
• 18:07
  Dr. Jason Bock: 'cause disruption in healthcare, you know, is hard and there's a lot of entrenched interests and this is the way we do things and this is how financially everything holds together.
• 18:19
  Dr. Jason Bock: Cell therapy upends that.
• 18:21
  Dr. Jason Bock: Now.
• 18:21
  Dr. Jason Bock: My hope is that at the end of the day, they're more a co, there are more cost effective treatments.
• 18:28
  Dr. Jason Bock: And they make patients healthy for longer periods of time.
• 18:33
  Dr. Jason Bock: Like I, I think if we looked, I'm sure they have the data, if you looked at the quality of life of those two groups of patients over those two years, it would be dramatically different too if you're in and out of the hospital, uh, all the time versus, okay, I got, you know, a week or two in the hospital and then I'm done.
• 18:53
  David: Got it.
• 18:54
  David: So it sounds like, so I, I went in the direction that, you know, you said away from what you do, which is, I understand, is how to make some of these therapies actually how to scale them up and, and, and make them effective.
• 19:04
  David: Does that include cost effectiveness?
• 19:06
  David: Gimme a sense of the, kind of the economics of actually putting these together and how that may change at some more scale.
• 19:11
  Dr. Jason Bock: Right.
• 19:13
  Dr. Jason Bock: So, uh, we shouldn't underestimate the challenge of this new modality and how to build a entire.
• 19:21
  Dr. Jason Bock: Infrastructure and supply chain around it.
• 19:24
  Dr. Jason Bock: It's a whole different approach when you are making an individual treatment for each patient, right?
• 19:31
  Dr. Jason Bock: For most therapeutic small molecules, pills, we all take, or even monoclonal antibodies, which are injections.
• 19:39
  Dr. Jason Bock: Um, or you do protein therapeutics like ozempic, you can produce huge batches of those, produce hundreds of thousands of doses at a time.
• 19:49
  Dr. Jason Bock: Then just, just distribute those to pharmacies so you can have a very centralized supply chain, which were, you know, gotten very good at optimizing for cell therapies where each batch is for an individual patient.
• 20:08
  Dr. Jason Bock: It's a completely different model of manufacturing.
• 20:12
  Dr. Jason Bock: It's gonna take us time.
• 20:13
  Dr. Jason Bock: It's been slower than I would've hoped.
• 20:15
  Dr. Jason Bock: Um, but it, it's also reasonable to expect that that model is gonna take us more time to develop.
• 20:22
  Dr. Jason Bock: One of the foundational elements that's different that we think is important is this, the, the, the shape and location of that supply.
• 20:32
  Dr. Jason Bock: So, as I mentioned before, with very centrally produced products, you can produce those anywhere in the world in a big factory and then just ship the product to the hospitals, wherever they need the pharmacies.
• 20:45
  Dr. Jason Bock: But when you're making these, um, individual very personalized treatments, one of our thesis is that proximity to the patients, which are essentially.
• 20:57
  Dr. Jason Bock: The raw materials or where we starting point for each of the batches has a lot of benefits.
• 21:03
  Dr. Jason Bock: And so when, when we started CTMC, it was part of MD Anderson Cancer Center, um, and we're in close proximity.
• 21:11
  Dr. Jason Bock: I, um, uh, with this camera view, I can't see, but I can look right out my window here and I can see MD Anderson, uh, two blocks down the street.
• 21:20
  Dr. Jason Bock: And so when we.
• 21:22
  Dr. Jason Bock: Produce a batch for MD Anderson.
• 21:24
  Dr. Jason Bock: They're, you know, the shipping is putting it on a, a shuttle bus that gets to us in five minutes.
• 21:30
  Dr. Jason Bock: It's not arranging airfare and transport and all of that.
• 21:34
  Dr. Jason Bock: And I think over time the, uh, uh, uh, closer relationship between healthcare providers, hospitals.
• 21:45
  Dr. Jason Bock: Clinics and manufacturing sites for cell therapies is gonna be an important, um, solution to reducing waiting times and, uh, costs overall.
• 21:59
  Dr. Jason Bock: Uh, so we believe like regionalized manufacturing that is connected to hospital like geographies is gonna be an important way of scaling cell therapies.
• 22:12
  David: Let's talk about, uh, the impact of policy changes.
• 22:16
  David: There's a lot going on in Washington, DC and at the state level, but let's focus on, on Washington, uh, regarding healthcare policy and how does that kind of focus down into the cell and gene therapy, uh, area?
• 22:30
  Dr. Jason Bock: Yeah, I think, uh, while there's, uh, talk about disruption, there's a lot of disruption going on.
• 22:38
  Dr. Jason Bock: I, I think there's a lot of opportunities for cell therapies and we've seen some very positive signs.
• 22:45
  Dr. Jason Bock: Um, one thing that's obviously important to this administration is, you know, onshoring of manufacturing.
• 22:53
  Dr. Jason Bock: And by definition, when you have this regionalized manufacturing supporting geographies, it's gonna be lo located, like specifically within the us.
• 23:04
  Dr. Jason Bock: Also for other countries, which are.
• 23:07
  Dr. Jason Bock: Um, also getting on board with, you know, having control over their, their healthcare.
• 23:14
  Dr. Jason Bock: They want, um, manufacturing, uh, in their country as well.
• 23:20
  Dr. Jason Bock: Cell therapy leads itself very much to benefit from that regionalized manufacturing.
• 23:26
  Dr. Jason Bock: And so I think there's, there's a lot of appetite, I think from the us but as well as other geographies.
• 23:33
  Dr. Jason Bock: For building, uh, cell therapy manufacturing capabilities.
• 23:36
  Dr. Jason Bock: And we're in discussion with a number of different, uh, major hospital networks, uh, in the US as well as internationally to help them establish that.
• 23:48
  Dr. Jason Bock: So that's one aspect.
• 23:49
  Dr. Jason Bock: Um, the other is, uh, in the US a real fresh look at, um, are we providing patients.
• 24:00
  Dr. Jason Bock: Like, you know, the, um, most impactful care.
• 24:04
  Dr. Jason Bock: It goes really, David, to your point earlier, are we just extending life by a month or two months or are we really trying to do transformation that is, uh, you know, really impacting their overall health?
• 24:20
  Dr. Jason Bock: And so there was a remarkable, um, kind of town hall with the leadership of HHS, uh, F-D-A-C-M-S.
• 24:30
  Dr. Jason Bock: Uh, that came together specifically to talk about cell and gene therapy.
• 24:33
  Dr. Jason Bock: This was, um, I think in June.
• 24:37
  Dr. Jason Bock: Um, and they've vo voiced tremendous support for the cell therapy industry and really, uh, breathed a lot of excitement into the field.
• 24:49
  Dr. Jason Bock: Um, and we've seen some aspects of, hey, smaller trials where we know these treatments are very impactful, let's get them commercially approved quicker, and then have follow on studies after commercial approval to, um, you know, fully understand them.
• 25:07
  Dr. Jason Bock: But don't put so much onus on these very transformational therapies to prove everything when you're in the clinical stage.
• 25:16
  Dr. Jason Bock: I think that kind of, um.
• 25:19
  Dr. Jason Bock: Uh, mindset will have a, a, a very positive impact for transformational therapies like cell and gene therapies.
• 25:30
  David: When we look at the, you know, overall healthcare policy and spending and, and legislation, what I see is something that is a little bit less enlightened.
• 25:39
  David: So when we see that, you know, there's these big cuts going on in Medicaid, perhaps Medicare, depending on how you look at it, um.
• 25:47
  David: It's not being done by having, you know, new technologies or, you know, breakthroughs in, uh, in how, uh, how conditions are treated or paid for.
• 25:57
  David: It's really putting up more bureaucratic barriers to people getting access.
• 26:00
  David: That's, that's a lot of why there's gonna be fewer people on Medicaid.
• 26:03
  David: That's, that's really accounting for a lot of the savings.
• 26:06
  David: So when we look at, um, you know, cell therapy, first of all, you will get caught up into that to some extent anyway, but let's talk about maybe the.
• 26:14
  David: Payment models and what could work.
• 26:15
  David: So, so let's take, let's take it as a given the, say, 700,000 versus $1.3 million example that you gave before.
• 26:23
  David: Uh, others won't take it as a given, but let's, let's take it as twice as expensive to have something that's worse, but is more in the current, uh, you call it dealer's choice, standard of care, whatever it may be.
• 26:34
  David: The payment system is set up around that.
• 26:37
  David: The the old model and so it's easier to pay 1.3 million in the existing model than 700,000 in the new one.
• 26:43
  David: Yeah.
• 26:44
  David: Yes.
• 26:44
  David: Are we seeing alternative payment models that are promising or like what needs to happen to be able to have something that logically makes sense actually work in the system financially?
• 26:54
  David: Yeah,
• 26:55
  Dr. Jason Bock: exactly.
• 26:56
  Dr. Jason Bock: Fantastic question.
• 26:57
  Dr. Jason Bock: Um.
• 26:59
  Dr. Jason Bock: You know, I think there's the ex ex you, you framed it so well.
• 27:02
  Dr. Jason Bock: I like, I like the way that you say that you're, you know, paying more for worse outcomes.
• 27:07
  Dr. Jason Bock: That's something we gotta fix.
• 27:09
  Dr. Jason Bock: Now the challenge for us, I think, is that it's a, a little bit of a, um, uh, it's, it's just due to the way our system is set up and with these, um.
• 27:23
  Dr. Jason Bock: Upfront costs for a one-time potentially curative treatment.
• 27:27
  Dr. Jason Bock: So, you know, most of our healthcare, uh, is provided through employer based, uh, insurance.
• 27:36
  Dr. Jason Bock: And if you change employers, you're, you, uh, change, uh, typically insurance companies.
• 27:42
  Dr. Jason Bock: And so the problem for us and the challenge is, hey.
• 27:49
  Dr. Jason Bock: You going back to our earlier example, if you go in and you have multiple myeloma and you get the cell therapy and you have to pay for that upfront, the 700 k upfront, uh, and then six months later you change jobs.
• 28:03
  Dr. Jason Bock: Well, the insurance company who pays that upfront cost doesn't sort of reap the benefits of like those lower costs, uh, longer term, whereas, um.
• 28:15
  Dr. Jason Bock: If it's more, you know, you're paying a higher amount, but it's like ongoing for those two years at least those costs, you know, could sort of follow you, um, through your different, uh, companies and insurance companies.
• 28:29
  Dr. Jason Bock: So I think it's a little bit of a, like cork in how our insurance reimbursement works now.
• 28:36
  Dr. Jason Bock: There's been some interesting developments and, and David, this is a little outside my area.
• 28:40
  Dr. Jason Bock: I'm more about like.
• 28:42
  Dr. Jason Bock: Scaling up and making, uh, these therapies.
• 28:45
  Dr. Jason Bock: But CMS has some interesting new initiatives with, uh, states to try and come up with ways of, uh, bridging this, bridging this gap.
• 28:57
  Dr. Jason Bock: Maybe moving to more like, I think you intimating subscription models.
• 29:02
  Dr. Jason Bock: And so, you know, I think it's, I I think they would have tremendous, uh, value in.
• 29:11
  Dr. Jason Bock: Um, hey, if you get an upfront, if you, if you get a one-time treatment, it's almost like you have a subscription to that every year that you're cancer free, you continue to pay.
• 29:22
  Dr. Jason Bock: That defers some of the upfront costs, and if these treatments are as good as I'm portraying them, uh, long term, it makes for financial viability for the industry and overall will be cost effective for, for patients in the overall system.
• 29:38
  Dr. Jason Bock: So we just have to figure out a way of getting all those things connected.
• 29:42
  Dr. Jason Bock: There's a lot of entrenched interests, which are used to the way of doing things.
• 29:47
  Dr. Jason Bock: And so, uh, but I've been encouraged by some recent pilot studies that are ongoing.
• 29:52
  David: Well, you know, beyond, um, the, the scope of this conversation, but it will also be interesting to look at, uh, international models for this because as you were mentioning, this industry's gonna spring up around the world.
• 30:04
  David: Yeah.
• 30:04
  David: 'cause it needs to be local and, and each one of those health systems has their own way of paying, which are usually different here.
• 30:09
  David: Sometimes what I've found is that, you know, we complain here about, you know, it's too short term and then it, you look abroad and they also have these short term problems as well and, and less money overall.
• 30:18
  David: But there should be some innovation I think that we can learn from.
• 30:22
  David: On the payment side as well from elsewhere.
• 30:23
  Dr. Jason Bock: Yeah.
• 30:24
  Dr. Jason Bock: And if I could pick up on that too.
• 30:26
  Dr. Jason Bock: 'cause I think innovation too on the payment side, but also innovation on the product side is going to continue.
• 30:34
  Dr. Jason Bock: So these are the first generation products and I think, you know, if we put this in context, nowadays, monoclonal antibodies are very standard of care.
• 30:45
  Dr. Jason Bock: And everyone's like, oh, monoclonal antibodies great.
• 30:48
  Dr. Jason Bock: They help a lot of patients.
• 30:50
  Dr. Jason Bock: They are, uh, a lot of them are in clinical development.
• 30:53
  Dr. Jason Bock: There's a lot of innovation that goes on there.
• 30:56
  Dr. Jason Bock: They're profitable for pharmaceutical companies, so it builds a good positive ecosystem.
• 31:02
  Dr. Jason Bock: But that wasn't always the case.
• 31:04
  Dr. Jason Bock: It, it, it's, we're we're 40 years in to the monoclonal antibody, um, uh, modality.
• 31:12
  Dr. Jason Bock: And so, uh, those first 10, 15 years.
• 31:18
  Dr. Jason Bock: Maybe 20 years.
• 31:19
  Dr. Jason Bock: Monoclonal cannabis were very much fit and start, and they were, you know, a lot of the same things I hear about cell therapies.
• 31:29
  Dr. Jason Bock: They cost too much.
• 31:31
  Dr. Jason Bock: Um, how are we gonna administer them?
• 31:34
  Dr. Jason Bock: Um, you know, patients won't take them, um, all have sort of fallen by the wayside.
• 31:43
  Dr. Jason Bock: As we innovated both on the product side, made safer antibodies, made more potent antibodies, and on the manufacturing side, figured out how to reduce the cost of goods.
• 31:53
  Dr. Jason Bock: And the same will happen with cell therapies.
• 31:56
  Dr. Jason Bock: We're gonna fight, make.
• 31:59
  Dr. Jason Bock: Better products.
• 32:00
  Dr. Jason Bock: We're gonna figure out how to make them more successfully and at lower cost, and we're gonna figure out how to make them more accessible to patients.
• 32:08
  Dr. Jason Bock: So to me, it's an inevitability.
• 32:11
  Dr. Jason Bock: It's just how long it is gonna take for us to get there.
• 32:14
  Dr. Jason Bock: But we're gonna get there.
• 32:16
  David: So I have, uh, I do have a magic wand, but I also have a long enough memory to, to recall that 40 years ago actually when this, when this came out, and I, I seem to recall a cover story on Time Magazine.
• 32:28
  David: It would actually be interesting to go back and find that.
• 32:30
  David: And they're talking about the promise of, but a lot of it was focused at the time on is a secure for cancer, et cetera.
• 32:36
  David: Um, and be interested to see what they talked about in terms of the overall, uh, economics.
• 32:41
  David: And the system wasn't, we weren't taking as much.
• 32:43
  David: Up as much, uh, of the GDP with healthcare as we are now.
• 32:46
  David: But it might be interesting to go and learn some lessons from that.
• 32:49
  David: Right?
• 32:49
  Dr. Jason Bock: I mean, if you remember back, you know, this is when most, uh, therapies were given as pills, antibodies have to be injected, usually an IV infusion, and you know, so many pe this is 30 years ago, so many people like.
• 33:05
  Dr. Jason Bock: Hey, there's not enough infusions that you cannot administer wide enough, uh, treatments via iv.
• 33:12
  Dr. Jason Bock: It's just like, unless you can make, uh, uh, antibodies orally available, it's n never gonna go anywhere.
• 33:19
  Dr. Jason Bock: And today it's, you know, the, the, the best selling products in the world, in the most transformational therapies for cancer and other diseases.
• 33:28
  Dr. Jason Bock: Monoclonal antibodies.
• 33:30
  David: Nice.
• 33:31
  David: Jason, I'm gonna end on a question that I ask everybody, uh, which is whether you have a, a book that you would recommend, uh, to our audience.
• 33:39
  Dr. Jason Bock: Oh, good question, David.
• 33:41
  Dr. Jason Bock: Actually, wait a bit.
• 33:44
  David: Yeah.
• 33:45
  David: Like even if you have it in stock, you know, even better, but Okay.
• 33:49
  Dr. Jason Bock: I forgot you were gonna ask me, but yeah.
• 33:50
  Dr. Jason Bock: You know, this book, I, I really like this book.
• 33:53
  Dr. Jason Bock: Um, okay, so free advertising.
• 33:56
  Dr. Jason Bock: Uh.
• 33:57
  Dr. Jason Bock: Cure within.
• 33:59
  Dr. Jason Bock: Um, it's very approachable.
• 34:02
  Dr. Jason Bock: And basically each chapter, uh, the author talked with a luminary in the immunotherapy field and just got him to explain the historical context for what their insight was that moved the field forward.
• 34:23
  Dr. Jason Bock: Because to me it's, it, it's very, um.
• 34:27
  Dr. Jason Bock: It really sets the context that 30 years ago there was a widely held belief in oncology that the immune system had nothing to do with cancer surveillance and anything.
• 34:42
  Dr. Jason Bock: You know, a lot of the chemotherapy drugs we give to patients, they sort of, you know, kill off the immune system as a byproduct, unfortunately.
• 34:51
  Dr. Jason Bock: Um.
• 34:52
  Dr. Jason Bock: And you know, these immuno oncologists in the nineties, even in the early two thousands were, uh, a bit of a outcast group at these big cancer conferences.
• 35:05
  Dr. Jason Bock: They would be in the basement, like huddled together, talking about their latest discoveries, and then a number of these guys continued to push through the dark times.
• 35:15
  Dr. Jason Bock: And whether it was Jim Allison, who's at MD Anderson and Nobel Laureate.
• 35:20
  Dr. Jason Bock: Uh, coming up with the whole concept of checkpoint inhibitors, um, or other approaches, it's been revolutionary for the field to understand the impact of the immune system on cancer.
• 35:32
  Dr. Jason Bock: And so this book is very approachable for that history from these individuals and what their perspective was, uh, from the dark days, uh, why they continued to believe and push the whole field forward, to open our eyes to the power of the immune system.
• 35:49
  Dr. Jason Bock: Uh, for cancer.
• 35:50
  David: Excellent.
• 35:51
  David: Well, that's it for yet another episode of the Health Bizz Podcast.
• 35:54
  David: My guest today has been Dr. Jason Bock.
• 35:56
  David: He's co-founder and CEO of CTMC, which is a joint venture between national resilience and MD Anderson Cancer Center, focused on accelerating development and manufacturing of innovative cell therapies to cure cancer.
• 36:11
  David: Did you like the show?
• 36:12
  David: I hope you will subscribe and leave a review.
• 36:14
  David: And meanwhile, Jason, thank you so much
• 36:17
  Dr. Jason Bock: David.
• 36:17
  Dr. Jason Bock: Thank you.
• 36:18
  Dr. Jason Bock: And hey, use that magic wand very judiciously.
• 36:22
  David: Will do.