Researchers are developing techniques to genetically modify cancer-fighting immune cells directly inside patients rather than in expensive laboratory facilities, potentially making CAR-T therapy accessible to far more people.

Current CAR-T treatments require removing a patient's T cells, shipping them to specialized facilities for genetic engineering, then returning them weeks later at costs around $500,000 per dose. The new "in vivo" approaches use viral vectors or RNA-loaded nanoparticles to deliver genetic instructions directly to T cells circulating in the bloodstream, which could reduce costs by an order of magnitude. Companies including Capstan Therapeutics, co-founded by Nobel laureates, and AstraZeneca-backed EsoBiotec have launched early human trials. While only about 200 US centers currently offer traditional CAR-T therapy, the approach could make the powerful treatment available on demand like conventional drugs.

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