Background and Objective:
In 2019 neoplasms rose to be the second global cause of DALYs. The social and economic burden of cancer impacts patients, healthcare systems and countries’ health expenditures. While prevention and early detection should be at the forefront of public health action, effective treatment could reduce both the social and economic burden of cancer. Cellular therapies for cancer have recently advanced to a new stage of success with chimeric antigen receptor (CAR) T cell therapy for the treatment of acute lymphoblastic leukemia. The unrivaled response rates this therapy achieved opened the floodgates for research investment and strides into the translation of these results to other malignancies. It also becomes clear that most health care systems are not prepared for the high costs associated with the presently near to prohibitive high cost of personalized cellular therapies.

Methods:
We systematically reviewed all current clinical trials in the field and broke these results down in patient individual therapy versus off-the-shelf approaches, as well as targeted tumors and patient populations that can benefit from these therapies. We will also go over technological breakthroughs that can lead to mass production and the ethical implications of failing to implement such cost-lowering technologies.

Results:
Currently there are 6 clinically approved CAR T products for hematological malignancies and more than 1000 clinical trials ongoing, more than 500 of these currently recruiting. CAR T cell therapy products currently in the market have an approximate cost of $370.000 for the payer - a cost significantly higher than that of targeted therapies. Furthermore, we highlight efforts in the field of gene and cell engineering to optimize production and scalability.

Conclusion:
Personalized cancer therapy heralds both the potential to enable the treatment of malignancies that are currently palliative and to be the straw that breaks traditional public health care systems.