CAR-T has 'landed,' and the gene therapies need a 'bespoke' approach, says Aradigm CEO Will Shrank, M.D.

Cell and gene therapy often get lumped together in a single category, but there are important distinctions between them — and among the gene therapies, says Will Shrank, M.D.

It is important to recognize, says Shrank, “that the sickle cell [gene therapy] treatment looks really different from spinal muscular atrophy [gene therapy], which looks really different from Duchenne muscular dystrophy, which looks really different from hemophilia. In some ways you almost have to look at each of these treatments, indications, modalities as its own entity that we try to manage.”

Shrank, a longtime member of the Managed Healthcare Executive (MHE) editorial advisory board, is CEO and co-founder of Aradigm, a startup company that is positioning itself as a benefits platform for cell and gene therapies that will assume financial risk for the expensive therapies and manage their cost for payers. Aradigm is backed by $25 million in investment from Frist Cressey Ventures, Andreessen Horowitz and Morgan Health, a division of JPMorgan Chase.

In this segment of an extended interview with MHE, Shrank speaks about cell and gene therapy as a category of therapy. Chimeric antigen receptor T cell (CAR-T), a cell therapy, presents a different set of issues than gene therapies, he says.

CAR-T is a really different modality, in part, because we know a lot about it,” says Shrank. “That’s sort of the one that’s landed, and it works. We now are seeing really considerable growth in the use of CAR-T as an earlier line of therapy for hematologic cancers, but also just really extraordinary evidence around the ability to use these therapies for new indications — solid tumors, autoimmune conditions — which will massively expand their use. These are therapies that 10 years ago, seven years ago, seemed very experimental and had all kinds of FDA requirements around monitoring. Those have been lifted. And these therapies are going to be delivered in community settings and will be much more accessible. The prices are now much more predictable.”

The current array of gene therapies requires a “truly bespoke, indication-by-indication approach to really helping make sure that patients have affordable, sustainable access to these therapies,” says Shrank.