Right. It's the solid tumor market that is where DCVax is likely to have it's most significant impact. That's the same market I would think Gilead intends to go after with their T Cell Receptor (TCR) technology.
With CAR-T therapy, the risks of life-threatening cytokine release syndrome (CRS) and neurologic toxicities risks have so far been worth the risks. Patients with relapsed or refractory large B-cell lymphoma don't have any other sufficient choices, so such risks are worth the reward of a potential remission. Plus, and correct me if I'm wrong, in diffuse large B-cell lymphoma (DLBCL) patients, they engineer the T cells with one target - the antigen CD19 - and this is found on BOTH normal and cancerous B cells. That means these engineered T cells attack both the normal and the cancerous B cells (I know, flipper has been stating this for a long time now). Eliminating these normal B cells can cause B cell aplasia which can result in long-lasting hypogammaglobulinemia . This unfortunate side effect can be managed with monthly immunoglobulin replacement infusions to prevent severe infections.
Hypogammaglobulinemia: is an immune disorder characterized by a reduction in all types of gamma globulins, including antibodies that help fight infection. It may be congenital (present at birth), related to medication; it may be due to a kidney or gastrointestinal condition, cancer or severe burns.
From what I can tell, KITE (now Gilead) was going after the solid tumor market (like Direct will) with engineered (?) T Cell Receptors (TCRs) in their MAGE P1 trials.
I'm not sure if CAR-Ts are being used to treat solid tumors; if they were, I'd think they'd have to engineer T cells to attack the antigens on the tumor. And in this case, there are usually significantly more than one. So I'm not sure if there are plenty of normal cells of the same cancerous cells - and if CAR-T could differentiate between the two, as it seems it can't differentiate between CD19 with the current approved version. It will be interesting to see work around for this as CAR-T therapies evolve and new generations emerge.
Still with DC-Vax Direct, those life-threatening risks are so far, are MIA for the patients. That is one reason, IMO, perhaps why the assault to NWBO may have been so forceful and aggressive. Low, low risk... high reward for some, good reward for others is hard to compete against.
