SHANGHAI—Michael Walters, 25, had just begun his first full-time job out of university when he was diagnosed last year with non-Hodgkin lymphoma, a blood cancer.
Walters, who hails from New Zealand, underwent several unsuccessful rounds of chemotherapy, radiotherapy and immunotherapy in Auckland. Then doctors told him about CAR-T treatment, in which a patient’s immune cells are extracted, re-engineered in a laboratory and reintroduced into the body to fight cancer cells.
Walters looked at the U.S. and India as well as Australia, where a hospital in Melbourne said it could treat him with the therapy—at a cost of as much as $600,000, a prohibitive sum for his family.
At SinoUnited Hospital in Shanghai, Walters paid less than half that amount—and, on Aug. 18, learned that the treatment had succeeded in pushing his lymphoma into complete remission.
“I feel more appreciative of life,” Walters said. “If this was 10 or 15 years ago, I wouldn’t have this option.”
CAR-T therapy, short for chimeric antigen receptor T-cell therapy, was pioneered in the U.S. Today, however, Shanghai is emerging as a favored destination for patients from America and other rich countries—a testament not only to China’s low costs but also to the country’s emergence as an innovator in biotechnology.
“China has basically done to CAR-T cell therapy the same thing that it’s done to other industries, which is, they’ve industrialized it,” said Sairah Ahmed, director of the CAR-T program in the department of lymphoma and myeloma at the University of Texas MD Anderson Cancer Center in Houston.
In some cases, China has jumped ahead of the U.S. In June, Beijing regulators greenlighted a CAR-T treatment for a cancer of the stomach and upper small intestine—the world’s first approved CAR-T therapy for solid tumors.
Josh Bronkhorst, the 59-year-old chief executive of a financial services company, was among the first to get the treatment after approval. Diagnosed in December, he went through four months of chemotherapy and immunotherapy—only to find that the tumor was still growing.
His doctors told him another round of chemotherapy would have only a 15% chance of success. So Bronkhorst, also a New Zealander, headed to China.
“Every day is getting better,” Bronkhorst said in a faint voice on Aug. 6 from his bed at Jiahui International Hospital in Shanghai. By then, 10 days after the re-engineered cells were infused into his body, the buildup of extra fluids caused by Bronkhorst’s cancer had come to a halt, allowing doctors to remove a drainage tube.
“It’s not a miracle drug, but this was by far the best option I could find,” he said at the time.
On Aug. 16, he flew back to New Zealand, where he continues to recover.
Ahmed of MD Anderson said she has advised some of her overseas patients to seek treatment in China, where CAR-T therapy can range between $150,000 and $230,000, versus $550,000 to $850,000 in the U.S.
Regulators in dozens of countries have approved CAR-T therapy for blood cancers, including leukemia, lymphoma and myeloma. The therapies Bronkhorst and Walters received are among nine CAR-T products approved by Chinese regulators, the most in the world.
Bronkhorst’s stomach-cancer treatment was developed by Shanghai-based CARsgen Therapeutics, which won Chinese approval for the solid tumor CAR-T therapy following a clinical-trial program that included U.S. patients at MD Anderson and Mayo Clinic in Minnesota.
“We have more and more new weapons to fight cancer,” Li Zonghai, founder and chief executive of CARsgen, said in an interview. “A lot of people said we couldn’t treat it, and now there are more and more modalities—so many treatment options.”
For all of its advances, China has also found itself in controversy over the transparency of its clinical trials, after three people, including a 6-year-old girl, were reported to have died while receiving experimental medicines. In general, Chinese regulators allow hospitals to start clinical trials with less central government oversight than the U.S. requires—a system that has enabled innovation but also increased risks for patients in trials.
By contrast, China’s private international hospitals have generally been more cautious, steering clear of clinical trials and sticking only to therapies, including CAR-T treatments, that have been approved by regulators for commercialization.
Harnessing the immune system to attack cancer is the principle behind many of this century’s medical advances, and the pace is accelerating.
In August, Cambridge, Mass.-based Moderna and its partner Merck said their mRNA-based vaccine succeeded in preventing cancer from coming back or spreading in high-risk melanoma patients. The potential breakthrough could extend the lifespans of hundreds of thousands of people with the deadly skin cancer.
Meanwhile, the Food and Drug Administration last month approved a therapy for pancreatic tumors, a breakthrough in fighting one of the deadliest forms of cancer.
Chinese regulators first granted approval for CAR-T therapy to be administered to overseas patients in 2021. Since it began offering CAR-T in 2023, Shanghai SinoUnited Hospital has treated roughly three dozen patients from 12 countries, said Dr. Kathy Shi, the hospital’s founder and chief executive. Shi, a cardiologist who did her postdoctoral work at Emory University in Atlanta, said most of them were now cancer-free.
As word has spread, SinoUnited Hospital says it has welcomed patients from MD Anderson, Mayo Clinic and Johns Hopkins Hospital in Baltimore. Shi says the hospital has also seen an uptick in inquiries from across the U.S., Canada, Europe and Southeast Asia.
“A year ago, I was frequently talking to Chinese patients seeking international treatment,” said Xuan Linli, chief of medical oncology at Jiahui Hospital. “Now, more and more overseas patients are requesting consultations with us.”
CAR-T therapies have been studied in the U.S. since the 1980s and in China since the 1990s. A breakthrough came in 2012 when Pennsylvania native Emily Whitehead, then 6 years old, became the first child to beat leukemia after undergoing the therapy. (She is now an undergraduate at the University of Pennsylvania, steps from where she received her CAR-T treatment.)
CAR-T remains a niche within cancer treatment because it can treat a limited number of cancer types. For now, CAR-T treatment generally comes only after other treatments have failed, in part because of potential side effects such as inflammation caused by the infusion.
Patients choose China not merely for the low cost of treatment, but because the country’s international hospitals offer a range of services—a critical factor, since CAR-T therapy can require intensive care and intervention from cardiologists, neurologists and other specialists.
Because CAR-T requires tailor-made cellular therapy for each patient, China’s ability to crank out the therapies in a matter of days—in laboratories just a short drive from Shanghai—can give it an edge over countries where the wait is longer.
The possibility of immediate treatment in China makes it an attractive choice for patients fighting aggressive cancers.
Bronkhorst and Walters also describe better customer service than they found when considering other countries, including help in securing medical visas and a higher level of English-language proficiency.
Walters said he was reassured when he got on a video call with SinoUnited Hospital hematologist Lily Zhou, who did her postdoctoral work at the University of California, San Francisco.
In New Zealand, “I felt like I had done more research and knew more about it than the doctors I was talking to,” Walters said. “But she has so much experience.…It was nice to talk to someone who knew exactly what she was doing.”
Walters and his friends started a crowdfunding effort online to cover most of the costs, and in late June he flew to Shanghai to begin his treatment under Zhou. It was his first time traveling there. On his 25th birthday, the staff at SinoUnited Hospital presented him with a cake.
For his next birthday, he is planning to be home in Auckland, with his cancer still in remission.
“I’d give anything to be healthy right now,” Walters said. “I want to be able to worry about the normal everyday things that everyone worries about: university, work, girlfriends, gossip.”
Zhao Yueling contributed to this article.
Write to Jonathan Cheng at Jonathan.Cheng@wsj.com
