CAR T-cell therapy now covered by NHI for two-year period

Taipei, Nov. 3 (CNA) Patients with two types of cancers who get CAR T-cell treatment costing millions of Taiwan dollars will now be covered by Taiwan's national health insurance (NHI) system, as the National Health Insurance Administration (NHIA) indicated in October.

Starting Nov. 1, the treatment is covered under the NHI system for patients with B-cell acute lymphoblastic leukemia (B-ALL), one of the most common types of childhood cancer, or relapsed or refractory diffuse large B cell lymphoma (DLBCL) that meet certain criteria.

The coverage is critical for patients because the therapy, which takes immune T cells and modifies them with chimeric antigen receptors, or CARs, so that they can recognize and destroy cancer cells, is expensive.

According to Huang Yu-wen (黃育文), director of the NHIA's Medical Review and Pharmaceutical Benefits Division, it costs around NT$8.19 million (US$253,821).

Given the high cost, the NHIA has limited coverage to two types of patients and to a period of up to two years, but more discussions will be held to decide if the coverage should go on for longer, said NHIA Director-General Shih Chung-liang (石崇良).

Taiwan's Food and Drug Administration previously approved the use of CAR-T cell therapy for all B-cell ALL patients aged 25 or under and for DLBCL patients whose cancers have relapsed or not responded to first or second-line treatments.

To be eligible for national health insurance coverage under the new program, however, B-ALL patients must be aged 25 and under and have a leukemia that did not respond to other treatments, a relapse after a bone marrow transplant, or more than one relapse.

As for DLBCL patients, they will be eligible if their cancer has recurred or not responded to treatments considered to be second-line or higher.

For many of these cancer patients, the CAR-T cell therapy could be life-saving when other treatments do not work.

According to Huang Wei-han (黃威翰), deputy director of Hualien Tzu Chi Hospital's (HTCH) Cell Therapy Center, 15-20 percent of young B-ALL patients have relapses, and only 30-50 percent of those who have relapses survive for five years.

About half of adult patients will relapse and only 10 percent of them will survive for five years, he said.

In 2022, a 10-year-old girl who had been battling B-ALL for more than four years became the first patient in Taiwan to be successfully treated with CAR-T cell therapy.

Meanwhile, bone marrow transplants do not work for roughly half of DLBCL patients, and those diagnosed with a cancer that has not responded to treatment or whose cancer has relapsed after a bone marrow transplant have only a 20 percent chance of surviving for two years, he said.

Huang Tai-chung (黃泰中), attending physician of hematology at National Taiwan University Hospital (NTHU) and secretary general of the Hematology Society of Taiwan, said 40 percent of DLBCL patients can be completely cancer free after receiving CAR T-cell treatment, while another 13 percent will be partially cured.

"Even if their cancer is only partially cured, it means a lot to the patients," he said, because it can help prepare them for the next stage of treatment.

According to Huang Tai-chung, 60 percent of B-cell ALL patients whose bone marrow transplants have failed can be completely cured through the use of CAR T-cell treatment.

At present, patients can receive CAR T-cell treatment at seven hospitals around Taiwan -- NTHU, National Taiwan University Cancer Center, Linkou Chang Gung Memorial Hospital, China Medical University Hospital, Taichung Veterans General Hospital, Kaohsiung Medical University Chung-Ho Memorial Hospital and HTCH, Shih said.

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