As head of Roche’s pharma division, Daniel O’Day was notoriously cautious about Car-T, refusing to take his company into any cell therapy deals. It will come as cold comfort that his first year as chief executive of Gilead will have proved his scepticism to have been well placed. 2019 sales of Gilead’s Car-T therapy Yescarta yesterday came in at $456m, missing sellside consensus of $474m, according to EvaluatePharma, and comprising an anaemic 3% quarter-on-quarter increase; this means that Yescarta revenues have been flat for three straight quarters. And Gilead’s financials revealed another Car-T-related impairment: $800m, “primarily related to the treatment of indolent non-Hodgkin lymphoma”, adding to an $820m write-off for the discontinuation of the BCMA-targeting Car-T asset KITE-585 a year ago. Gilead’s immediate Car-T hopes now rest on KTE-X19 – the Yescarta construct but with a modified manufacturing process – which is filed for mantle cell lymphoma, and on Zuma-7, a phase III study that reads out in the second half and seeks to expand Yescarta’s lymphoma use from third to second line. Ultimately, Mr O’Day will have to decide how much funding to devote to Gilead’s cell therapy pipeline, or indeed to business development in this area.