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Framing regenerative medicine: culturally specific stories of an emerging technoscience. BIOSOCIETIES 2021. [DOI: 10.1057/s41292-021-00236-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Lindenberg M, Retèl V, Rohaan M, van den Berg J, Haanen J, van Harten W. Evaluating different adoption scenarios for TIL-therapy and the influence on its (early) cost-effectiveness. BMC Cancer 2020; 20:712. [PMID: 32736535 PMCID: PMC7393723 DOI: 10.1186/s12885-020-07166-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 07/10/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Treatment with tumor-Infiltrating Lymphocytes (TIL) is an innovative therapy for advanced melanoma with promising clinical phase I/II study results and likely beneficial cost-effectiveness. As a randomized controlled trial on the effectiveness of TIL therapy in advanced melanoma compared to ipilimumab is still ongoing, adoption of TIL therapy by the field is confronted with uncertainty. To deal with this, scenario drafting can be used to identify potential barriers and enables the subsequent anticipation on these barriers. This study aims to inform adoption decisions of TIL by evaluating various scenarios and evaluate their effect on the cost-effectiveness. METHODS First, 14 adoption scenarios for TIL-therapy were drafted using a Delphi approach with a group of involved experts. Second, the likelihood of the scenarios taking place within 5 years was surveyed among international experts using a web-based questionnaire. Third, based on the questionnaire results and recent literature, scenarios were labeled as being either "likely" or "-unlikely". Finally, the cost-effectiveness of TIL treatment involving the "likely" scored scenarios was calculated. RESULTS Twenty-nine experts from 12 countries completed the questionnaire. The scenarios showed an average likelihood ranging from 29 to 58%, indicating that future developments of TIL-therapy were surrounded with quite some uncertainty. Eight of the 14 scenarios were labeled as "likely". The net monetary benefit per patient is presented as a measure of cost-effectiveness, where a positive value means that a scenario is cost-effective. For six of these scenarios the cost-effectiveness was calculated: "Commercialization of TIL production" (the price was assumed to be 3 times the manufacturing costs in the academic setting) (-€51,550), "Pharmaceutical companies lowering the prices of ipilimumab" (€11,420), "Using TIL-therapy combined with ipilimumab" (-€10,840), "Automatic TIL production" (€22,670), "TIL more effective" (€23,270), "Less Interleukin-2" (€20,370). CONCLUSIONS Incorporating possible future developments, TIL-therapy was calculated to be cost-effective compared to ipilimumab in the majority of "likely" scenarios. These scenarios could function as facilitators for adoption. Contrary, TIL therapy was expected to not be cost-effective when sold at commercial prices, or when combined with ipilimumab. These scenarios should be considered in the adoption decision as these may act as crucial barriers.
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Affiliation(s)
- Melanie Lindenberg
- Division of Psychosocial Research and Epidemiology, the Netherlands Cancer Institute - Antoni van Leeuwenhoek hospital, Amsterdam, The Netherlands.,Department of Health Technology and Services Research, University of Twente, MB-HTSR, PO Box 217, 7500AE, Enschede, The Netherlands
| | - Valesca Retèl
- Division of Psychosocial Research and Epidemiology, the Netherlands Cancer Institute - Antoni van Leeuwenhoek hospital, Amsterdam, The Netherlands.,Department of Health Technology and Services Research, University of Twente, MB-HTSR, PO Box 217, 7500AE, Enschede, The Netherlands
| | - Maartje Rohaan
- Department of Medical Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek hospital, Amsterdam, The Netherlands
| | - Joost van den Berg
- Biotherapeutics Unit (BTU), The Netherlands Cancer Institute - Antoni van Leeuwenhoek hospital, Amsterdam, The Netherlands
| | - John Haanen
- Department of Medical Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek hospital, Amsterdam, The Netherlands
| | - Wim van Harten
- Division of Psychosocial Research and Epidemiology, the Netherlands Cancer Institute - Antoni van Leeuwenhoek hospital, Amsterdam, The Netherlands. .,Department of Health Technology and Services Research, University of Twente, MB-HTSR, PO Box 217, 7500AE, Enschede, The Netherlands.
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Lindenberg MA, Retèl VP, van den Berg JH, Geukes Foppen MH, Haanen JB, van Harten WH. Treatment With Tumor-infiltrating Lymphocytes in Advanced Melanoma: Evaluation of Early Clinical Implementation of an Advanced Therapy Medicinal Product. J Immunother 2019; 41:413-425. [PMID: 30300260 PMCID: PMC6200372 DOI: 10.1097/cji.0000000000000245] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 08/06/2018] [Indexed: 12/18/2022]
Abstract
Tumor-infiltrating lymphocytes (TIL)-therapy in advanced melanoma is an advanced therapy medicinal product (ATMP) which, despite promising results, has not been implemented widely. In a European setting, TIL-therapy has been in use since 2011 and is currently being evaluated in a randomized controlled trial. As clinical implementation of ATMPs is challenging, this study aims to evaluate early application of TIL-therapy, through the application of a constructive technology assessment (CTA). First the literature on ATMP barriers and facilitators in clinical translation was summarized. Subsequently, application of TIL-therapy was evaluated through semistructured interviews with 26 stakeholders according to 6 CTA domains: clinical, economic, patient-related, organizational, technical, and future. In addition, treatment costs were estimated. A number of barriers to clinical translation were identified in the literature, including: inadequate financial support, lack of regulatory knowledge, risks in using live tissues, and the complex path to market approval. Innovative reimbursement procedures could particularly facilitate translation. The CTA survey of TIL-therapy acknowledged these barriers, and revealed the following facilitators: the expected effectiveness resulting in institutional support for an internal pilot, the results of which led to the inclusion of TIL-therapy in a national coverage with evidence development program, the availability of an in-house pharmacist, quality assurance expertise and a TIL-skilled technician. Institutional and national implementation of TIL-therapy remains complex. The promising clinical effectiveness is expected to facilitate the adoption of TIL-therapy, especially when validated through a randomized controlled trial. Innovative and conditional reimbursement procedures, together with the organization of knowledge transfer, could support and improve clinical translation of TIL and ATMPs.
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Affiliation(s)
- Melanie A. Lindenberg
- Division of Psychosocial Research and Epidemiology
- Department of Health Technology and Services research, University of Twente, Enschede, The Netherlands
| | - Valesca P. Retèl
- Division of Psychosocial Research and Epidemiology
- Department of Health Technology and Services research, University of Twente, Enschede, The Netherlands
| | | | - Marnix H. Geukes Foppen
- Division of Molecular Oncology and Immunology
- Department of Medical Oncology, The Netherlands Cancer Institute—Antoni van Leeuwenhoek, Amsterdam
| | - John B. Haanen
- Division of Molecular Oncology and Immunology
- Department of Medical Oncology, The Netherlands Cancer Institute—Antoni van Leeuwenhoek, Amsterdam
| | - Wim H. van Harten
- Division of Psychosocial Research and Epidemiology
- Department of Health Technology and Services research, University of Twente, Enschede, The Netherlands
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Abstract
Many countries have identified regenerative medicine as a strategic priority, and have thus launched a range of initiatives to facilitate innovation in the field. This perspective paper argues that several initiatives involve resource distributions that could impinge on widely accepted egalitarian notions of fairness and justice that underpin current healthcare systems. Specifically, this paper focuses on five initiatives, and argues that these initiatives reflect a largely unacknowledged utilitarian perspective on distributive justice. The intention of this paper is not to argue against these initiatives, but rather to stimulate an open discussion on what qualifies as a just and fair system of resource distribution, so that the regenerative medicine field can responsibly deliver on its clinical potential.
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Affiliation(s)
- John Gardner
- Department of Sociology, School of Social Sciences, Monash University, W414 Menzies Building, 20 Chancellors Walk, Clayton, Melbourne, 3800, Australia
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Papadaki M. Adaptation through Collaboration: Developing Novel Platforms to Advance the Delivery of Advanced Therapies to Patients. Front Med (Lausanne) 2017; 4:56. [PMID: 28611985 PMCID: PMC5447030 DOI: 10.3389/fmed.2017.00056] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 04/27/2017] [Indexed: 12/23/2022] Open
Abstract
For the nascent field of advanced therapies, collaboration will be a game-changer, turning scientific progress that was once unimaginable into transformative medical practice. Despite promise for lifelong management and even cure of disease, skepticism remains about the feasibility of their delivery to patients, fueling investment risks. With the potential for long-term effectiveness in need of frequent reassessment, current approaches to predict real-life drug performance bear little relevance, necessitating novel and iterative schemes to monitoring the benefit–risk profiles throughout the life span of advanced therapies. This work explains that reinventing an adoption route for Advanced Therapy Medicinal Products is as much about the scientific and clinical components, as it is about the organizational structures, requiring an unprecedented level of interactions between stakeholders not traditionally connected; from developers and regulators, to payers, patients, and funders. By reflecting on the successes and lessons learned from the growing space of global precompetitive consortia and public–private partnerships, as well as a number of emerging accelerated development pathways, this work aims to inform the foundations for a future roadmap that can smooth the path to approval, reimbursement, and access, while delivering value to all stakeholders. Echoing the growing demands to bring these transformative products to patients, it provides critical insights to enhance our capacity in three fundamental domains: deploying the operational flexibilities offered by the growing space of collaborations, utilizing emerging flexible and accelerated pathways to tackle challenges in quantifying long-term effectiveness, and building the necessary digital and clinical infrastructure for knowledge development.
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Affiliation(s)
- Magdalini Papadaki
- Association of the British Pharmaceutical Industry, London, United Kingdom
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Gurtner GC, Chapman MA. Regenerative Medicine: Charting a New Course in Wound Healing. Adv Wound Care (New Rochelle) 2016; 5:314-328. [PMID: 27366592 PMCID: PMC4900191 DOI: 10.1089/wound.2015.0663] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 07/13/2015] [Indexed: 12/13/2022] Open
Abstract
Significance: Chronic wounds are a prevalent and costly problem in the United States. Improved treatments are needed to heal these wounds and prevent serious complications such as infection and amputation. Recent Advances: In wound healing, as in other areas of medicine, technologies that have the potential to regenerate as opposed to repair tissue are gaining ground. These include customizable nanofiber matrices incorporating novel materials; a variety of autologous and allogeneic cell types at various stages of differentiation (e.g., pluripotent, terminally differentiated); peptides; proteins; small molecules; RNA inhibitors; and gene therapies. Critical Issues: Wound healing is a logical target for regenerative medicine due to the accessibility and structure of skin, the regenerative nature of healing, the lack of good limb salvage treatments, and the current use of cell therapies. However, more extensive knowledge of pathophysiologic targets is needed to inform regenerative strategies, and new technologies must demonstrate value in terms of outcomes and related health economic measures to achieve successful market access and penetration. Future Directions: Due to similarities in cell pathways and developmental mechanisms, regenerative technologies developed in one therapeutic area may be applicable to others. Approaches that proceed from human genomic or other big data sources to models are becoming increasingly common and will likely suggest novel therapeutic avenues. To fully capitalize on the advances in regenerative medicine, studies must demonstrate the value of new therapies in identified patient populations, and sponsors must work with regulatory agencies to develop appropriate dossiers supporting timely approval.
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Gardner J, Webster A. The social management of biomedical novelty: Facilitating translation in regenerative medicine. Soc Sci Med 2016; 156:90-7. [DOI: 10.1016/j.socscimed.2016.03.025] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 03/15/2016] [Accepted: 03/16/2016] [Indexed: 11/25/2022]
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Uenoyama A, Kakizaki I, Shiomi A, Saito N, Hara Y, Saito T, Ohnuki H, Kato H, Takagi R, Maeda T, Izumi K. Effects of C-xylopyranoside derivative on epithelial regeneration in an in vitro 3D oral mucosa model. Biosci Biotechnol Biochem 2016; 80:1344-55. [PMID: 26966997 DOI: 10.1080/09168451.2016.1153957] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Identifying substandard tissue-engineered oral mucosa grafts with a poor epithelium before clinical use is critical to ensure quality assurance/control in regenerative medicine, leading to success of grafting. This study investigated the effects of one of the C-xylopyranoside derivatives, β-D-xylopyranoside-n-propane-2-one (XPP), on oral epithelial regeneration. Using a three-dimensional oral mucosa model, we analyzed changes of the epithelial structure, glycosaminoglycan (GAG) synthesis, the expression levels of basement membrane zone markers, and substrates of Akt/mTOR signaling. Compared with the control, 2 mM XPP treatment increased the mean and minimal epithelial thickness, and reduced the variation of epithelial thickness. It also stimulated expressions of decorin and syndecan-1 with change of GAG amount and/or composition, and enhanced the expressions of integrin α6, CD44, and Akt/mTOR signaling substrates. These findings suggest that XPP supplementation contributes to consistent epithelial regeneration. Moreover, upregulation of those markers may play a role in increasing the quality of the oral mucosal epithelium.
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Affiliation(s)
- Atsushi Uenoyama
- a Division of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences , Niigata University , Niigata , Japan.,b Division of Oral Anatomy, Graduate School of Medical and Dental Sciences , Niigata University , Niigata , Japan
| | - Ikuko Kakizaki
- c Department of Glycotechnology, Center for Advanced Medical Research , Hirosaki University, Graduate School of Medicine , Hirosaski , Japan
| | - Aki Shiomi
- d Division of Dental Educational Research Development, Graduate School of Medical and Dental Sciences , Niigata University , Niigata , Japan
| | - Naoaki Saito
- b Division of Oral Anatomy, Graduate School of Medical and Dental Sciences , Niigata University , Niigata , Japan
| | - Yuko Hara
- a Division of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences , Niigata University , Niigata , Japan.,e Division of Biomimetics, Graduate School of Medical and Dental Sciences , Niigata University , Niigata, Japan
| | - Taro Saito
- a Division of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences , Niigata University , Niigata , Japan
| | - Hisashi Ohnuki
- a Division of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences , Niigata University , Niigata , Japan
| | - Hiroko Kato
- e Division of Biomimetics, Graduate School of Medical and Dental Sciences , Niigata University , Niigata, Japan.,f Research Center for Advanced Oral Science, Graduate School of Medical and Dental Sciences , Niigata University , Niigata , Japan
| | - Ritsuo Takagi
- a Division of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences , Niigata University , Niigata , Japan
| | - Takeyasu Maeda
- b Division of Oral Anatomy, Graduate School of Medical and Dental Sciences , Niigata University , Niigata , Japan.,f Research Center for Advanced Oral Science, Graduate School of Medical and Dental Sciences , Niigata University , Niigata , Japan
| | - Kenji Izumi
- e Division of Biomimetics, Graduate School of Medical and Dental Sciences , Niigata University , Niigata, Japan
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Gardner J, Faulkner A, Mahalatchimy A, Webster A. Are there specific translational challenges in regenerative medicine? Lessons from other fields. Regen Med 2015; 10:885-95. [PMID: 26541074 DOI: 10.2217/rme.15.50] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
There is concern that translation 'from bench to bedside' within regenerative medicine (RM) will fail to materialize, or will be dismally slow, due to various challenges arising from the highly novel and disruptive nature of RM. In this article, we provide a summary of these challenges, and we critically engage with the notion that such challenges are specific to RM. It is important, we argue, not to overstate the exceptional nature of RM, as valuable lessons can be learned from elsewhere in medicine. Using several examples of technology adoption, we suggest that emerging RM products and procedures will have to work hard to find or create an adoption space if translation into the clinic is to be successful.
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Affiliation(s)
- John Gardner
- Science & Technology Studies Unit, Department of Sociology, University of York, Wentworth College, York, Y010 5DD, UK
| | - Alex Faulkner
- Sociology of Biomedicine & Healthcare Policy, Centre for Global Health Policy, University of Sussex, Brighton, BN1 9RH, UK
| | | | - Andrew Webster
- Science & Technology Studies Unit, Department of Sociology, University of York, Wentworth College, York, Y010 5DD, UK
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