Jennifer N. Brudno, an Associate Research Physician at the National Cancer Institute, shares her expertise on CAR T-cell therapy. The discussion highlights how genetically engineered T cells specifically target and kill tumor cells, showing promise against various B cell malignancies. Brudno also delves into the side effects, like cytokine release syndrome and neurological toxicities, while addressing FDA concerns over secondary malignancies. Plus, logistical challenges and advancements in making these therapies more accessible are explored, painting a comprehensive picture of CAR T-cell therapy's impact.
CAR T cell therapy utilizes genetically modified T cells to target and kill specific cancer cells, with significant success in hematologic malignancies.
The treatment process involves collecting, engineering, and infusing T cells, facing challenges like high costs and wait times affecting patient outcomes.
Deep dives
Understanding CAR T Cell Therapy
CAR T cell therapy involves genetically engineering a patient's own T lymphocytes to express a chimeric antigen receptor (CAR) that targets specific cancer antigens. This synthetic protein allows T cells to recognize and attack malignant cells displaying the target antigen, such as CD19 in certain B-cell malignancies. The effectiveness of CAR T cell therapy varies by the type of cancer being treated, but notable successes have been recorded in patients with B-cell acute lymphoblastic leukemia (ALL) and diffuse large B-cell lymphoma, with long-term remission rates reaching around 30% and up to 90%, respectively. This therapy has the potential to provide an effective treatment option for individuals who do not respond to conventional chemotherapy.
The Process and Administration of CAR T Cell Therapy
The administration of CAR T cell therapy begins with the collection of a patient’s T cells, typically through a process called leukapheresis, which resembles a blood transfusion. Once collected, the T cells are sent to a central facility for genetic engineering, where they are modified to express the CAR and subsequently multiplied. After a conditioning chemotherapy regimen to prime the patient's immune system, the engineered CAR T cells are infused back into the patient, where they can proliferate and potentially lead to long-lasting responses. This therapy is generally considered a 'one and done' approach, although patients need close monitoring for potential side effects following the infusion.
Challenges and Advancements in CAR T Cell Therapy
Despite its promise, CAR T cell therapy faces significant challenges, including lengthy wait times between cell collection and infusion, with potential delays of several weeks that could compromise patient outcomes. The high cost of therapy presents another barrier, as it can exceed hundreds of thousands of dollars, raising concerns about accessibility for patients across different healthcare systems. Recent advancements include FDA approvals for new cellular therapies targeting solid tumors, showcasing progress in the field of adoptive immunotherapy. Ongoing research is focused on enhancing the effectiveness of CAR T cell therapy and expanding its applicability to a broader range of cancers, including solid tumors, which previously had limited treatment options.
CAR T cells are genetically engineered to express a receptor that recognizes and kills tumor cells. CAR T-cell products are now FDA approved for 6 hematologic malignancies. Author Jennifer N. Brudno, MD, National Cancer Institute, joins JAMA Deputy Editor Mary McGrae McDermott, MD, to discuss "CAR T Cells and T-Cell Therapies for Cancer: A Translational Science Review.” Related Content: