As part of World Cancer Day (4th Feb), the journal of Molecular Oncology invited researchers to take part in a writing competition aimed at highlight existing or future policies directed at making cancer treatment equally accessible to all patients both locally and globally. This entry, by Tamanna Bostani (The University of Edinburgh, UK), received the co-third prize.

Much like Jack’s beanstalk stretching towards the heavens, the potential of CAR-T cell therapy offers a towering promise in the fight against cancer. Yet, its costs remain a steep climb for many in low- and middle-income countries (LMICs). This revolutionary treatment reprograms patients’ T cells with a Chimeric Antigen Receptor (CAR), enabling precise targeting and destruction of tumour cells. CAR-T therapy has shown groundbreaking success in treating haematological malignancies like leukaemia and lymphomas and is now expanding into solid tumours such as glioblastoma and lung cancer (1).  However, its costs £300,000 per patient in the UK and up to $1 million in the US (2)(3) puts it out of reach for many and creates a financial burden for healthcare systems. Access is determined by economic wealth, not medical need, exposing a critical disparity in healthcare equity.

To address this, a dual-policy approach combining government-Led CAR-T price regulation and local CAR-T manufacturing in LMICs is essential. Imagine CAR-T cell therapy as golden beans —a life-changing treasure that seems out of reach. Like Jacks clever trade of his cow for the magical beans that grew into something extraordinary, CAR-T therapy can be brought to those who need it most through strategic negotiations and investments. A global CAR-T Fund could be a pivotal strategy to make this treatment more accessible, particularly in LMICs. Consider models like GAVI, an international collaboration which brought vaccines to remote areas by pooling resources and negotiating lower prices with manufacturers (4). Governments could negotiate lower prices with pharmaceutical companies and invest in local production to ensure more affordable access to CAR-T therapies. For example, the PEPFAR initiative worked with funders and the most affected countries, providing antiretroviral therapy millions (5). Similarly, the EU's Joint Procurement Model has demonstrated how collective action can secure lower drug prices for member states, suggesting that a similar approach could help make expensive therapies like CAR-T cell treatment more accessible (6).

However, policy should be more than a temporary fix; it must plant the seed of long-term sustainability. Like Jack’s beans sprouting into a beanstalk, local CAR-T therapy manufacturing can grow into a self-sustaining solution. Countries like China, India, and Spain, have already begun producing CAR-T cells locally. China, with over half of global CAR-T trials has developed robust manufacturing capabilities, including commercial-scale facilities like CARsgen in Shanghai (7). In Spain, hospitals have developed cost-effective manufacturing processes, offering CAR-T therapy for as low as $97,000 in Barcelona (8). India’s approval of actalycabtagene autoleucel (NexCAR19) at a significantly lower price than global standards represents a promising step towards affordability, portraying effective solutions through local manufacturing and strategic pricing agreements (9).

These stories are not fairytales; with the right investment, the right policies, and the right vision, LMICs can reduce their dependency on expensive imports and high-priced therapies, building a sustainable, equitable future for their patients and making CAR-T therapy accessible to those who need it most. 

References

1. Maalej KM, Merhi M, Inchakalody VP, Mestiri S, Alam M, Maccalli C, et al. CAR-cell therapy in the era of solid tumor treatment: current challenges and emerging therapeutic advances. Mol Cancer [Internet]. 2023 Jan 30;22(1):20. Available from: https://pubmed.ncbi.nlm.nih.gov/36717905/
2. Odstrcil MS, Lee CJ, Sobieski CE, Weisdorf DJ, Couriel DR. Access to CAR T-cell therapy: Focus on diversity, equity and inclusion. Blood Rev. 2023 Oct 1;101136-6.
3. Scheffer ER, Kelkar AH, Russler-Germain DA, Tessema FA, Raymakers A, Feldman WB, et al. High cost of Chimeric Antigen Receptor T-cells: challenges and solutions. Am Soc Clin Oncol Educ Book. 2023 Jun 1;43(43).
4. Brooks A, Habimana D, Huckerby G. Making the leap into the next generation: A commentary on how Gavi, the Vaccine Alliance is supporting countries’ supply chain transformations in 2016-2020. Vaccine. 2017 Apr;35(17):2110-4.
5. El-Sadr WM, Holmes CB, Mugyenyi P, Thirumurthy H, Ellerbrock T, Ferris R, et al. Scale-up of HIV treatment through PEPFAR. JAIDS J Acquir Immune Defic Syndr. 2012 Aug;60:S96-104.
6. Signing ceremonies for Joint Procurement Agreement [Internet]. Public Health. 2025 [cited 2025 Mar 3]. Available from: https://health.ec.europa.eu/health-security-and-infectious-diseases/preparedness-and-response-planning/signing-ceremonies-joint-procurement-agreement_en
7. Hillman A, Vaidya M. Tracking the rise of CAR-Ts in China: the dawn of an immunotherapy superpower? Pharm Tech [Internet]. 2022 [cited 2025 Mar 3]. Available from: https://www.pharmaceutical-technology.com/features/tracking-the-rise-of-car-ts-in-china-the-dawn-of-an-immunotherapy-superpower/
8. Ways to curb the sky-high costs of CAR-T cell therapy [Internet]. BioInformant. 2025 [cited 2025 Mar 3]. Available from: https://bioinformant.com/ways-to-curb-the-sky-high-costs-of-car-t-cell-therapy/
9. Mallapaty S. Cutting-edge CAR-T cancer therapy is now made in India — at one-tenth the cost. Nature [Internet]. 2024 Mar 21. Available from: https://www.nature.com/articles/d41586-024-00809-y

I’m Tamanna Bostani, a second-year medical student at the University of Edinburgh. I completed this work as part of the Brennan Neurosurgical Research Group. I have a deep interest in neuroscience, oncology, and research, and I aspire to become an academic neurosurgeon. When I’m not studying or poring over scientific papers, I paint commissioned anatomical oil pieces, often filling canvases with sulci and gyri. I write poetry, read philosophy, and sprint. I am drawn to science for its elegant complexity, its unfathomable depth, and its profound capacity to sculpt lives in ways both subtle and seismic.