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Novartis AG (ADR)(NVS) just announced that the Food and Drug Administration (FDA) in the US has approved one of its lead oncology development assets, a drug called Kymriah (CTL019), in a target indication of patients up to 25 years of age with B-cell precursor acute lymphoblastic leukemia (ALL) that is refractory or in second or later relapse.

As is to be expected, the company has picked up a bit of strength on the back the news, currently trading for $83.24 and a market capitalization of a little over $191.3 billion. Aside from a couple of percentage points with evaluation, however, markets remain relatively flat on the update.

I think this ambiguity is unfounded and misplaced. The approval of Kymriah by the FDA is one of the most important milestones in oncology to have been reached in the past decade or more and the implications of the approval go way beyond the drug’s impact on Novartis’ top line.

Here is why.

The drug is, as mentioned, targeted towards an oncology indication – in this instance, ALL, a type of cancer in which the bone marrow of the patient makes too many white blood cells and this over-proliferation of white blood cells is at the root of the leukemia in question. These sorts of cancers are incredibly difficult to treat. They can’t be surgically removed (for the most part) because there isn’t a specific tumor! to get rid of. They also have mechanisms built-in by which they are able to hide from the immune system – be that through the release of certain proteins that deactivate system cells or through the expression of antigens that serve to cloak the cancerous cells from the T cells and B cells that would normally help resolve pathogenicity.

For the past decade or so, a form of immunotherapy called chimeric antigen receptor (CAR) T cell therapy has dominated the cutting edge of oncology. Most of the big names in healthcare have an asset somewhere in their pipeline that is built on the CAR-T mechanism and many have had decent results in early to mid stage testing of said assets.

The way these drugs work is through the engineering of T cells to express an antigen-receptor that is, in parallel, expressed by the cancer that the drug is trying to treat. When the engineered T cell is reintroduced into the body, it is able to recognize the cancer cells it is targeting by way of the antigen these cancer cells express and, in turn, is able to recruit the rest of the immune system to comment deal with the problem. In short, and conceptually, these sorts of treatments remove the cloaking associated with cancer in its natural disease form.

It has long been hailed as one of the only treatment types that has the potential to cure certain types of cancer as opposed to halt progression but to date, no company has managed to put forward a robust enough New Drug Application (NDA) in the US to warrant approval for commercialization.

Until now, that is.

The latest Novartis approval represents the first time the FDA has approved a CAR-T and, in this author’s opinion, opens the floodgates to a whole new wave of oncology therapy. If Novartis can successfully execute on a commercialization strategy for the asset, and can provide long-term follow-up data illustrating the impact that this drug can have not just in this population but in other tough to treat cancer types, it’s going to be first in a long line of companies big and small pickup a regulatory green light for that respective CAR-T assets.

Here are some companies that might be next in line for approval and are well worth keeping an eye on near term: Juno Therapeutics Inc (JUNO), Gilead Sciences, Inc. (GILD), GlaxoSmithKline plc (ADR)(GSK) and Pfizer Inc. (PFE).

Disclosure: The author has no positions in any of the stocks mentioned in this piece