In recent times, a post of “1.2 million yuan for one injection, two months to clear cancer cells” has sparked a national buzz, in addition to its own powerful anti-cancer functions, the high price of 1.2 million yuan for one injection is also very eye-catching, and there are even people who personally broke the news, claiming that they are the first case of successful treatment of “lymphoma” in the country. “The price of a 1.2 million yuan shot is also very attractive. Seeing such good news, everyone cheered for it. Many cancer patients and their family members have come to consult whether there is really such a “miracle drug” to fight cancer? Can a single injection really cure cancer? In fact, this is just a media hype. Here, let’s explore the truth behind this mysterious “anti-cancer miracle drug”. Emily, the world’s first child with acute lymphoblastic leukemia to receive CAR-T immunotherapy as early as April 2012, has survived cancer-free for 9 years. The 1.2 million dollar “anti-cancer miracle drug” is not a real miracle drug. The so-called miracle drug is a drug that can cure the disease, but obviously this 1.2 million dollar “anti-cancer miracle drug” cannot do that. To be precise, it is not a drug, but a kind of personalized cellular immunotherapy, also known as CAR-T therapy, i.e. chimeric antigen receptor T-cell therapy. In other words, the immune T cells are extracted from the patient, and then genetic engineering technology is used to modify the T cells so that they are equipped with tumor chimeric antigen receptors that specifically recognize cancer cells, just like equipping a missile with a high-precision navigator so that the T cells can efficiently recognize tumor cells in the body. These CAR-T cells are then cultured in large numbers in the laboratory, and the expanded “enhanced” immune T cells are then infused back into the patient. Once they meet the tumor cells expressing the corresponding antigens, they will be activated and re-expanded to kill the cancer cells through the immune killing mechanism, thus achieving the effect of curing or relieving the tumor. Although CAR-T cell therapy has powerful efficacy, the scope of indications is still very limited, CAR-T therapy was first listed in the U.S. in 2017, and the first one in China was listed in June this year, which is not suitable for all cancer treatments. , CAR-T therapy is currently indicated mainly for patients with relapsed, refractory hematologic diseases, including leukemia, lymphoma and multiple myeloma, after second-line or higher systemic therapy. In general, not all lymphoma patients need to use CAR-T therapy at the beginning, because 60% to 70% of patients with primary treatment can be cured by first-line standard treatment modalities, the majority of drugs are covered by health insurance, and the economic burden is not large. First-line tumor treatment refers to the most ideal, cost-effective and definitive treatment option. Second-line treatment is the treatment option taken after the failure of first-line treatment, or third-line treatment if second-line treatment still fails. Usually, every anti-tumor drug (or treatment technology) is pushed from the back line to the front line, i.e. if the third-line treatment works well, it will be pushed to the second line and then to the first line. For now, CAR-T technology is still the best option for salvage treatment (third-line treatment or above), and a lot of clinical trials and evidence-based medical evidence are needed to confirm the push to second-line and then to first-line. In addition, not all lymphoma patients are suitable for CAR-T therapy, for example, patients with very large masses, which can easily lead to tumor lysis syndrome, or patients with tumors in the brain, where the risk of CAR-T therapy is also high. CAR-T therapy has gone through a history of more than 20 years from early basic research and development to clinical application. From 2011 when clinical studies were initially shown to be effective to 2017 when the first foreign CAR-T cell product was approved for marketing, it has developed very fast compared to previous new technologies, but it is said to provide a new direction and a new beginning, but it also faces many problems that need to be solved. For example, solid tumors such as lung, liver, gastric and intestinal cancers are still in the trial stage and have not achieved major breakthroughs. This is mainly due to the difficulty of target selection and the relative difficulty of CAR-T cells entering solid tumor tissues, and even if they do, they are easily blocked by other immunosuppressive molecules or cells and cannot function, etc. In addition, not all patients receiving CAR-T therapy can completely achieve cancer cure, and a large proportion of patients still face the risk of recurrence after treatment remission. Clinically, the stratified management of patients after CAR-T therapy and the selection of subsequent bridging and maintenance therapy are also particularly important. The claim that cancer cells can be cleared with one injection is not rigorous. Two months after receiving CAR-T treatment, the patient underwent PET-CT examination and was found to have no cancer cells in her body. PET-CT is a combination of imaging and functional examination, which can see both the size of tumor and whether there is metabolism, but it cannot see cancer cells, which can only be seen through microscope. With the development of technology, in recent years, circulating tumor cells can also be found by liquid biopsy. Usually, tumor treatment is followed by imaging assessment of efficacy, which is classified according to tumor size: complete remission, partial remission, stable disease and disease progression. Even if the imaging efficacy assessment results in complete remission, the patient’s body is temporarily free of tumor manifestations and no tumor cells can be found on examination, it is not yet dare to say that it is a cure, and further long-term follow-up is needed. Imaging will still be performed again after every 3~6 months, and thereafter the patient will be under long-term follow-up observation for 5 years or even longer. And as time continues to pass, the likelihood of tumor recurrence will be less. If still no sign of tumor is found, then in terms of high probability, the possibility of achieving a cure in the future is high. The toxic side effects of CAR-T therapy are more and more dangerous, including cytokine release syndrome, neurotoxicity and tumor lysis syndrome. neurotoxicity, tumor lysis syndrome, etc. Cytokine storm and neurotoxicity are the most problematic: cytokine storm, often manifested as hyperthermia, hypotension, and shock, has an incidence of more than 60% to 70%, with the incidence of the more serious cytokine storm, about 20% to 30%. It usually requires glucocorticoids, IL-6 antibodies and other drugs for control. Neurotoxicity, mostly manifested as cerebral edema, increased intracranial pressure, epilepsy, altered state of consciousness, etc., the mechanism of its occurrence is still unclear, and there are reports from time to time abroad of patients passing away due to neurotoxicity caused by CAR-T, so the majority of patients should weigh the pros and cons. All in all, from personalization to the range of indications to side effects, CAR-T therapy is not destined to be an “anti-cancer miracle drug” for everyone. Patients should not follow the trend of CAR-T therapy, but should seek comprehensive evaluation from experts according to their own conditions before deciding whether to treat. After all, there is no “miracle drug” that can cure all diseases, and it is better to find one that is more suitable for you.