A lot of the initial cost is related to recouping some of the investment that's been made. We know that Gilead Sciences bought Kite Pharma, which is one of the leaders in this, for almost $12 billion. There's certainly a partnership between Celgene and Juno Therapeutics and the investors want to make back their money. There's a high cost initially, but this is not sustainable—especially if this technology is used across a wider frame. If it's used in myeloma, chronic lymphocytic leukemia, and in some solid tumors, how are we going to afford this? We should answer the first 2 questions first and the third question then becomes, perhaps, a stumbling block. I hope not.
Will we see more checkpoint inhibitors, such as pembrolizumab and nivolumab, playing big roles across these malignancies?
Well, I think so. We did one of the first trials in DLBCL in patients who already had a transplant. We had an international trial of 72 patients who received pidilizumab, which is probably one of the first checkpoint inhibitors. It turns out it may not work like a checkpoint inhibitor, so it's in the background now. However, we certainly saw very little toxicity with that drug.
There's a trial coming up…called the PLATFORM study, which is going to be combining the…checkpoint inhibitor durvalumab (Imfinzi) with CAR T cells in patients with DLBCL. It certainly makes sense that you begin to combine the checkpoint inhibitors with CAR T cells; however, the safety issues, how to work it, what the dose is, and what the sequencing should be still needs to be worked out. That's going to be the future of some of those trials. There's a place [for it], but we must be careful about integrating it into existing therapies.