How CAR T-cell therapy ‘cured’ 2 cancer patients

key takeaways

  • Chimeric Antigen Receptor (CAR) T-cell therapy is a cancer therapy approved by the U.S. Food and Drug Administration (FDA) for the treatment of certain leukemias and lymphomas.
  • Two patients treated with CAR T cells 10 years ago are still cancer-free a decade later, according to a new case study.
  • While CAR T-cell therapy is promising, it is not suitable for all patients or all types of cancer.

Two patients who developed chronic lymphocytic leukemia (CLL) in 2010 are still cancer-free a decade later after receiving a promising cancer treatment called CAR T-cell therapy, researchers announced.

Details of patient cases published in journal nature Early February 2022.

Can cancer be cured?

What is CAR T cell therapy?

Chimeric Antigen Receptor T cell therapy is often referred to as CAR T cell therapy. This is a cancer treatment that uses T cells – white blood cells that are an important part of the immune system.

In CAR T-cell therapy, a patient’s T-cell sample is brought to the lab. Some genes in cells are altered to make them better at finding proteins called antigens on cancer cells.

During this process, a chimeric antigen receptor (CAR) specific to the type of cancer the patient has is added to the T cells. From start to finish, it took several weeks to get the cells ready.

How Leukopheresis Works

When the altered cells are better able to fight cancer cells, they are put back into the patient by intravenous injection (infusion).

CAR T-cell therapy has been approved by the U.S. Food and Drug Administration (FDA) to treat different types of cancer, including leukemia, lymphoma, and myeloma.

However, CAR-T cell therapy also has some side effects, such as fever, chills, vomiting, dizziness, agitation and seizures. Therefore, patients are usually treated in specially trained medical centers.

Could Storing Immune Cells Help Prevent Future Disease?

Long-lasting CAR T-cell therapy

under these circumstances nature For the study, researchers followed three patients with chronic lymphocytic leukemia (CLL) – one of the most common leukemias in adults. This type of cancer starts in the bone marrow and enters the blood.

Dr. J. Joseph Melenhorst

Thanks to CAR T cell therapy, they can now do what they’ve always wanted to do and develop new hobbies.

— J. Joseph Melenhorst, Ph.D.

Two of the patients were in complete remission after being treated in 2010, study co-author Dr. J. Joseph Melenhorst, an immunologist at the University of Pennsylvania, told VigorTip.

The researchers analyzed the patients’ CAR T cells over time. A decade later, these cells are still destroying and attacking cancer in patients. No leukemia cells were found.

“Subjects treated with this therapy no longer have functional B cells (a type of lymphocytes that produce antibodies against bacteria and viruses),” Melenhorst said. “On the one hand, it’s a treatment, and on the other hand, cells are relatively well-managed in therapy.”

During the initial treatment phase, the subject’s immune response is dominated by CD8+ cells that directly attack cancer cells. Later, an unusual cytotoxic (ie, anticancer) CD4+ helper T cell begins to dominate the immune response and continues to attack cancer cells and maintain cancer remission.

“This is certainly a breakthrough. The subjects were diagnosed with chronic lymphocytic leukemia a long time ago, two or three years ago, and multiple therapies had failed,” Melenhorst said. “Because of CAR T-cell therapy, they can now do what they’ve always wanted to do and develop new hobbies.”

The role of T cells in cancer

treatment barriers

The patients received CAR T-cell therapy in 2010 as part of a trial at the University of Pennsylvania Abramson Cancer Center and Perelman School of Medicine in Philadelphia.

The trial led to the approval of the first CAR T-cell therapy in 2017, called Kymriah (tisagenlecleucel), for the treatment of children and young adults with refractory or relapsed B-cell acute lymphoblastic leukemia.

In 2018, the therapy was approved for certain adult patients with refractory or relapsed large B-cell lymphoma.

According to Melenhorst, CAR T-cell therapy is not currently FDA-approved for the treatment of CLL, but it is approved for other types of cancer.

“We can offer the same treatment for acute lymphoblastic leukemia (ALL), non-Hodgkin lymphoma and multiple myeloma through commercial entities,” Melenhorst said. “But with CLL, we have more work to do.”

There are other barriers to accessing CAR T-cell therapy, one of which is cost. The treatment itself could cost $300,000 to more than $400,000, Mellenhorst said.

CAR T cell cost

Currently, the FDA has approved five CAR T-cell therapies. The wholesale purchase cost of each drug — the price listed by the drugmaker — is well over $300,000:

  • Kymriah (tisagenlecleucel): $373,000–$475,000
  • Yescarta (axicabtagene ciloleucel): $399,000
  • Breyanzi (Lisocabtagene maraleucel): $410,300
  • Tecartus (brexucabtagene autoleucel): $399,000
  • Abecma (idecabtagene viclucel): $419,500

While the cost will certainly keep people from getting treatment, Mellenhorst said some patients are able to receive treatment because they are participating in a clinical trial.

“There’s a huge database of registered trials in the U.S. and elsewhere. At this point, you’ll find hundreds or even thousands of trials with CAR T cells as the primary therapy,” Melenhorst said, adding that CAR T cells “are now It is also being developed for use in immune diseases.”

Is cancer insurance worth the money?

CAR T cells for other cancers

While CAR T-cell therapy can provide long-lasting immunity in some types of cancer, the therapy is not suitable for all patients or all types of cancer.

Based on the results of this study, Melenhorst is now planning to study whether similar strategies and treatments could be applied to other blood cancers.

“We are also evaluating how this treatment and strategy can be applied to solid tumors, which are much more complex to treat than liquid tumors, blood cancers,” Melenhorst said. “This work really presents an opportunity to inspire more work using this approach in other cancers.”

How to use immunotherapy

Several types of cancer produce solid tumors that are surrounded by proteins and other cells that CAR T cells cannot reach and attack, Melenhorst added.

Other cell therapies being investigated include:

  • T cell receptor (TCR) therapy: T cells are taken from a patient and engineered to target specific proteins in cancer cells, then the modified cells are infused back into the patient
  • Tumor-infiltrating lymphocyte (TIL) therapy: uses T cells harvested from a patient and grown in the laboratory with substances produced by lymphocytes (lymphokines), and the modified cells are then infused back into the patient to attack tumor cells
  • Natural Killer (NK) Cell Therapy: Using Donor Lymphocytes to Attack Abnormal Cells

what does this mean to you

CAR T-cell therapy is a promising approach to treating certain cancers. Recently, researchers shared that two CLL patients were cancer-free after 10 years of treatment.

CAR T-cell therapy is not available for all types of cancer and is very expensive. Researchers are now investigating whether a similar immune cell therapy could help more patients with different types of cancer.

What is immunotherapy and how does it work?