CAR-T Cell Therapy: Evolution, Adoption, and the Road Ahead

Car t therapies

June 25, 2025

As a life sciences focused valuation and advisory firm, we observe the transformative potential of Chimeric Antigen Receptor T-cell (CAR-T) therapies. These cutting-edge treatments are reshaping the landscape of cancer care and hold promise far beyond their original indications. In this article, we provide a strategic overview of CAR-T therapy’s development, real-world adoption, and future outlook.

A Brief History of CAR-T Therapy

Chimeric Antigen Receptor T-cell (CAR-T) therapy has emerged after decades of pioneering research into harnessing the immune system against cancer. This personalized therapy involves extracting a patient’s T-cells, genetically modifying them to express synthetic receptors that target cancer-specific antigens, and reinfusing them to mount a focused immune response.

The first wave of success came in the early 2010s, particularly in pediatric acute lymphoblastic leukemia (ALL). The FDA’s landmark approval of Novartis’ Kymriah (tisagenlecleucel) in 2017 marked the beginning of a new era. Subsequent approvals included Yescarta (axicabtagene ciloleucel) for large B-cell lymphoma, followed by Tecartus, Breyanzi, Abecma, Carvykti, and most recently, Aucatzyl.

These therapies have demonstrated striking efficacy, especially in relapsed/refractory hematologic malignancies.

Yet, CAR-T is not without its hurdles—relapse due to antigen loss, logistical and manufacturing complexity, and significant cost barriers remain areas of active challenge and innovation.

Real-World Uptake: How the 7 Approved CAR-T Therapies Have Fared

As of 2025, the U.S. FDA has approved seven CAR-T therapies: Kymriah, Yescarta, Tecartus, Breyanzi, Abecma, Carvykti, and Aucatzyl. While initially expected to remain niche due to their high cost and complexity, adoption has exceeded early projections:

• Yescarta led the market with $1.6 billion in 2024 sales, driven by expanded indications and physician confidence.
• Kymriah earned $508 million in 2023, maintaining strong uptake in pediatric ALL and expanding into follicular lymphoma.
• Multiple myeloma therapies Abecma and Carvykti are growing rapidly; Carvykti’s 98% response rate positions it as a top performer.
• Tecartus and Breyanzi have also gained traction, with the former reaching $403 million in 2023.
• Aucatzyl, approved in 2024, is in its launch phase and is projected to follow similar growth patterns.

Source: Legend Biotech & annual accounts.

Originally seen as last-line treatments, CAR-Ts are increasingly being used earlier in the disease course. Improved manufacturing, supportive reimbursement frameworks, and global approvals (especially in China and India) have significantly broadened patient access.

Strategic Outlook: The Next Frontier for CAR-T

The CAR-T pipeline is rapidly evolving, with innovations poised to expand indications and improve delivery models with some key trends shaping the future:

  • Allogeneic (off-the-shelf) CAR-T cells are under development, promising reduced cost and turnaround time, though immunologic rejection is a critical hurdle. Examples of companies in this space are: Allogene Therapeutics, Adicet Bio and Caribou Biosciences.
  • Solid tumors represent the next major frontier; advanced CAR constructs and tumor microenvironment modulators are in focus (Kite/Gilead /A2Biotherapeutics).
  • As more patients survive longer, questions around re-dosing, relapse, and long-term immune effects are emerging. Companies are exploring next-gen CAR designs to improve durability and reduce antigen escape.
  • Intriguingly, CAR-Ts are now being explored for autoimmune diseases including lupus and multiple sclerosis, potentially transforming chronic care management (Cabaletta Bio/Kyverna Therapeutics and BMS).
  • Despite high per-treatment costs—often ranging from $400,000 to $500,000—payer confidence is growing thanks to compelling long-term remission and cost-effectiveness models.

Overview of Key Licensing Deals and Collaborations

The CAR-T therapy landscape has witnessed significant dealmaking activity, particularly through strategic partnerships between biotechnology innovators and large pharmaceutical companies. Below is an overview summarizing notable transactions, followed by an analysis of emerging trends.

Select CAR-T Licensing Deals and Collaborations (2018–2025)

Year Companies Involved Deal Value Stage Focus Area
2018 AbbVie & Calibr (Scripps Research) Undisclosed upfront + milestones Preclinical Switchable CAR-T for solid tumors
2021 Pfizer & Cellectis Undisclosed Preclinical 15 CAR-T targets in oncology
2023 Legend Biotech & Novartis $100M upfront + $1.01B milestones Preclinical DLL3-targeted CAR-T for solid tumors
2024 BioNTech & Autolus $250M ($50M cash + $200M equity) Phase I/II BNT211 (CLDN6+ solid tumors)
2024 Allogene Therapeutics & Arbor Biotechnologies Undisclosed Preclinical CRISPR-edited AlloCAR T™ for autoimmune diseases
2025 DAAN Biotherapeutics & GC Cell Upfront + milestones + royalties Preclinical Tumor antigen-specific CAR-T/NK

Key Trends in CAR-T Dealmaking

Earlier-Stage Partnerships

Big pharma increasingly licenses preclinical assets to secure rights to emerging technologies. Examples include:

  • AbbVie’s 2018 deal with Calibr for switchable CAR-T platforms.
  • Novartis’ 2023 agreement with Legend Biotech for DLL3-targeted CAR-T at the preclinical stage.

Focus on Solid Tumors and Allogeneic Platforms

  • Many of the recent deals involve solid tumor targets or allogeneic (off-the-shelf) CAR-T platforms
  • Allogeneic CAR-T partnerships, such as Allogene-Arbor (2024), aim to address manufacturing scalability.

Geographic Expansion

  • Deals increasingly include global rights, driven by approvals in China (Relma-cel, Yuanruida) and India (NexCAR19).

Conclusion

The CAR-T licensing landscape reflects a strategic shift by big pharma to secure innovative technologies early, mitigate R&D risks, and expand into underserved markets like solid tumors and autoimmune diseases. Deal values have surged, with preclinical-stage partnerships now dominating to capture first-mover advantages. The rise of allogeneic platforms and geographic diversification (particularly in Asia) underscores efforts to improve accessibility and scalability. However, challenges persist in areas such as manufacturing complexity and long-term durability, which may be addressed through next-gen engineering approaches.