Treatment for cancer is rigorous, often requires multiple strategies and medications are expensive. Pharmacy master's student Kristina Ellis is examining the effectiveness and affordability of the most innovative cancer treatments in recent years: CAR T-cell therapy. She created a video of her work and was a finalist in Waterloo's inaugural Gradflix competition.
GRADflix is an opportunity for graduate students to create a one minute (or less) video, moving slide show, or animation describing their research. The videos were judged on their communication, creativity and visual impact, and technical quality. The initiative was launched by Graduate Studies and Postdoctoral Affairs.
Ellis’ research summary was a finalist in the annual Gradflix video competition.
Chimeric-antigen receptor (CAR) T-cell therapy is a form of gene therapy designed to treat a subset of cancers of the blood and lymph nodes. It involves removing the T-cells of a patient with cancer, reprogramming those cells to attack the cancer, and then injecting them back into the patient’s body. It’s unlike any treatment currently in use. The first form of CAR T-cell therapy was approved by Health Canada in September 2018, and it’s anticipated that provincial and territorial regulatory bodies will soon be making decisions on how and when to fund the drug.
Ellis is conducting two projects that will generate findings to inform funding decisions about CAR T-cell therapy in a Canada. One is a qualitative study involving interviews with researchers, clinicians, policy makers, and other stakeholders with an interest in the new therapy.
The goal of this part of the study is to improve our understanding of the process of developing the therapy and delivering it to patients in need, said Ellis.
The second component of the project is a quantitative cost-effectiveness analysis that will examine how CAR T-cell therapy compares, cost-wise, to the typical standard of care in patients with aggressive large B-cell lymphomas.
“Unfortunately for patients with these types of lymphomas, they’ve often tried a few treatments that haven’t had success,” said Ellis, from the School of Pharmacy. “They have a poor prognosis and are treated with ‘salvage chemotherapy’ - the last effort when other drugs haven’t worked. It’s at this point that we would consider CAR T-cell therapy as an option.”
CAR T-cell therapy is exorbitantly expensive and while it can be successful for some patients, for others it can have serious and even fatal side effects such as triggering an aggressive immune system response. These risks make physician decisions about when to use the drug, and funding bodies’ decisions about when to cover the cost of the drug, especially challenging.
“By modelling the cost-effectiveness of CAR T-cell therapy, my research will generate findings that can support funding decisions about this new medication. I achieve this by inputting information such as efficacy and safety data, overall survival, and costs – of the drug, of the administration costs, of the adverse events, and more – I can build a model that will predict patient outcomes in the long-term, relative to the costs.”
Such economic models are standard resources for policy-makers, as they help ensure that funding decisions consider the wide variety of factors which impact paying for health care services. This type of work is new to Ellis, who first learned about economic modelling in a graduate class taught by her supervisor, Prof. William W.L. Wong.
“I had an interest in the cancer space from my time working at CADTH (Canadian Agency for Drugs and Technologies in Health) on the pan-Canadian Oncology Drug Review team. My thesis will contribute to a large-scale project that is a systems level policy model. It’s encouraging to play a role in comprehensive research that can inform health policy.”
After graduation, Ellis hopes to continue working in the health economics and informatics space. Her research has received support from BioCanRx.