There are 3 million people living with cancer in the UK, predicted to rise to 4 million by 2030[1]. Different societal groups are affected differently, in particular ethnic minorities who experience poorer outcomes[2]. Health inequalities are complex and their root causes diverse, including the fact that some cancers are more prevalent in specific communities[3]. Advanced research on targeted and personalised treatments can therefore bring hope to improve outcomes in the future and to “close the gap” in the access to cancer care. But how can these be made more affordable and included in holistic government strategies to manage cancer care?

At UCL, the Future Targeted Healthcare Manufacturing Hub (FTHM Hub), which brings together academics, manufacturers, and policymakers, has been addressing manufacturing, business, and regulatory challenges to ensure that new targeted biological medicines can be developed quickly and manufactured at a cost affordable to society. This includes innovative research on the manufacture of promising cancer therapies ranging from Chimeric antigen receptor T-cell (CAR-T) therapies through to targeted drug therapies such as antibody-drug conjugates and cancer vaccines. The Hub engages with and supports several clinical groups at UCL that develop advanced therapy medicinal products (ATMPs), some of which have been commercialised or are being translated into the clinic.

The FTHM Hub’s work also includes more fundamental research into optimising manufacturing by innovating processes and finding new ways of reducing production costs of these therapies. Examples of this activity include manufacturing autologous CAR-T therapy at the patient’s bedside or in an automated “GMP-in-a box” system[4], which can bring about benefits in terms of cost reductions, accelerating bench-to-bedside innovation, and mitigate risks that are generated by market shortages[5].

The Hub has worked closely with healthcare specialists and regulatory authorities to analyse how CAR-Ts and other high-cost therapies affect NHS England’s ability to resource other health services. It has conducted detailed supply chain economics analysis to identify key cost of goods drivers for CAR-T therapies, supply chain optimisation, and to assess the risk-reward trade-offs between centralised and distributed manufacture.

The recent agreement reached between the Department of Health and Social Care (DHSC), NHS England and the Association of the British Pharmaceutical Industry (ABPI) on a voluntary scheme for branded medicines pricing, access and growth is a welcomed programme to explore how industry and government can better work to support the delivery of new advanced treatments for cancer, but this is not enough.

Furthermore, and for this important work to continue, investment and support on advanced manufacturing is required to understand possible implementation challenges of novel options such GMP-in-a-box in clinical settings. The new UK’s life sciences manufacturing funding to build resilience for future health emergencies is a good opportunity to do this to expand on the FTHM Hub’s work and ensure every patient living with cancer will have accessibility of treatment irrespective of geographical location.

In addition, time and cost of travel to specialised centres can pose an economic burden to patients and carers due to disparities in cancer care. New centres will also need dedicated staff to help deliver advanced therapies and the FTHM Hub is also training a new generation of professionals to enable rollout of those to patients.

In the week that marks World Cancer Day, the FTHM Hub continues to develop important work to treat patients with cancer and it is our hope at the Policy Impact Unit that we can work towards imagining new futures together, close the care gap, and bring better outcomes for all of those living with cancer.

References

[1] https://www.macmillan.org.uk/dfsmedia/1a6f23537f7f4519bb0cf14c45b2a629/11424-10061/Macmillan%20statistics%20fact%20sheet%20February%202023

[2] Martins, T., Abel, G., Ukoumunne, O.C. et al. Ethnic inequalities in routes to diagnosis of cancer: a population-based UK cohort study. Br J Cancer 127, 863–871 (2022). https://doi.org/10.1038/s41416-022-01847-x

[3] Delon, C., Brown, K.F., Payne, N.W.S. et al. Differences in cancer incidence by broad ethnic group in England, 2013–2017. Br J Cancer 126, 1765–1773 (2022). https://doi.org/10.1038/s41416-022-01718-5

[4] Pereira Chilima, T. & S. Farid. 2019. ‘A roadmap to successful commercialization of autologous CAR T-cell products with centralized and bedside manufacture.’ Cell Gene Therapies VI 73. Comisel, R. 2022. Decisional Tools for Supply Chain Economics of Cell and Gene Therapy Products. Diss. UCL (University College London).

[5] Bicudo, E. & I. Brass. 2023, ‘Advanced therapies, hospital exemptions & marketing authorizations: the UK’s emerging regulatory framework for point-of-care manufacture’ Cell and Gene Therapy Insights 9(1), 101-120.