CAR T-cell therapy: Development to access
Howard “Skip” Burris, MD, the chief medical officer at Sarah Cannon Cancer Institute in Nashville, Tenn., joins the podcast as a guest host for a discussion on chimeric antigen receptor (CAR) T-cell therapy with Helen Heslop, MD, of Baylor College of Medicine, Houston. Dr. Heslop, who has been a leader in CAR T-cell therapy research, recently received a Lifetime Achievement Award from the American Society for Blood and Marrow Transplantation.
EP 14 Show Notes:
By Emily Bryer, DO, is a resident in the department of internal medicine, University of Pennsylvania, Philadelphia.
- Checkpoint inhibition is the main immunotherapy used in oncology; this allows endogenous T cells to react against targeted antigens on tumor cells.
- CAR T-cell therapy: Autologous product (T cells collected from recipient) are expanded ex vivo, genetically modified with chimeric antigen receptor, and then are reinfused into the patient.
- While antibody treatment can be used for multiple patients, CAR T-cell therapy is currently patient specific and autologous.
- Current candidates for CAR-T therapy:
- Acute lymphoblastic leukemia (ALL) in children and young adults.
- CD19 diffuse large B-cell lymphoma.
- There is a 40% response rate plateau at 2 years with CAR-T therapy, with lymphoma response rates lower than those of pediatric ALL.
- CAR T-cell therapies likely will continue to be done on an inpatient basis because of significant side effects:
- Cytokine release syndrome and neurotoxicity.
- Future directions for CAR-T therapy:
- Continue ongoing studies in mantle cell lymphoma and chronic lymphocytic leukemia.
- Investigate the potential to replace autologous transplant with CAR T-cell therapy.
- Maintain and enhance activity of CAR by promoting immune response with multiple antigens, such as CD19 + CD22.
- Reduce complications associated with CAR-T therapy.
- Study CAR-T therapy earlier in the disease process.
Image credit: Caron A. Jacobson and Jerome Ritz/Wikimedia Commons/Public Domain
- Image: Leukemia & Lymphoma Society
- June CH. Chimeric antigen receptor therapy. N Engl J Med. 2018 Jul 5;379(1):64-73.