They have been achieving more approval lately. There is no doubt, conjugates have improved dramatically over the decades. Forty years ago it sounded like an elegant idea, tie a poison to something that homes in on the tumor. It didn't sound nearly as complicated then as it's become as they've learned a great deal over those decades, but conjugates today are far superior because of all they've learned. I hated seeing IMGN bought out because I believed they had other blockbuster drugs moving forward in their pipeline.
CAR-T is of course a newer technology. While I didn't know of it when I first met my Dr. at City of Hope, he'd been working on it well before then, and that's over ten years ago. A patient I met about two months after my stem cell transplant had received his own stem cells the same day I did, then three days later his own T-cells modified with disable HIV. He initially hit a 107 fever, but they brought it down and he was at the point where he came in twice a month, while I was coming in twice a week. They don't need to be concerned with rejection when using your own cells, that wasn't the case for me. My Dr. said he hoped I'd never need T-cells, perhaps the biggest problem with them is the short period of time they're still active. The man I met had come out of remission and the T-cells were essentially his last chance to get another sustained remission as stem cells alone wouldn't do it. My original oncologist really didn't want to do stem cells once in remission, he felt they could do it if I came out, but after speaking with experts at both UCLA and City of Hope I learned a second remission often can't be achieved, better to do it when the first one is. Both UCLA and City of Hope were willing to do it at my advanced age, I liked the feeling I got at COH, but both are expert at cancer care. I did meet patients my age who'd been turned down at top flight Eastern hospitals for stem cells because of their age, even some of the best institutions protect their mortality figures and the risk for seniors is deemed to be greater. Before Covid COH would hold BMT reunions every year, I met some of their earliest marrow recipients who had over 40 years back then. At that time I don't believe they knew it was stem cells in the marrow that were actually doing the work. I'm not an expert, but I don't believe that marrow needs to be used in any transplant today, it's all about the stem cells.
Gary
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