Revolutionary CAR T-cell therapy offers hope against cancer

Your body’s immune system has specialized cells that fight off invaders like viruses, bacteria, parasites, and even harmful cancer cells.

A therapy first approved in 2017 takes that a step further and supercharges a person’s own cells to fight cancer cells. Called CAR T-cell therapy, the treatment has put some previously hard-to-treat blood cancers into curative remission. But doctors and researchers aren’t satisfied yet.

CAR T-cell therapy takes your own T-cells, a type of white blood cell, and adds a chimeric antigen receptor (CAR). This gives your T-cells the information they need to find and destroy cancer cells. After just one infusion, the modified cells continue to replicate in your body and provide protection.

“We use a term ‘living drugs’ because CAR T-cells live in a body even after patient is well,” said Veronika Bachanova, MD, PhD, a hematologist/oncologist with M Health Fairview and professor of medicine with University of Minnesota Medical School. “They keep working to prevent cancer recurrence.”

M Health Fairview is one of two health systems in Minnesota that offers CAR T-cell therapy. It’s the only one in the Twin Cities area. Bachanova explains CAR T-cell therapy.

What cancers can CAR T-cell therapy be used for?

Currently, the treatments are considered for people with blood cancers – including myeloma, lymphoma, and leukemia – that aren’t responding to other treatments, like chemotherapy. If a person’s cancer doesn’t respond to initial chemotherapy, they should be referred for CAR T-cell therapy consideration.

The treatment can potentially put people with B-cell lymphoma into curative remission. For myeloma, it can potentially extend time without cancer by several years, Bachanova said.

CAR T-cell therapies are being used to treat the following blood cancers, including:

• B-cell acute lymphoblastic leukemia
• Diffuse large B-cell lymphoma
• Follicular lymphoma
• High-grade B-cell lymphoma
• Mantle cell lymphoma
• Multiple myeloma
• Primary mediastinal large B-cell lymphoma

Research is underway to see if CAR T-cell therapies could be effective against other types of cancer.

“We’re moving closer to developing CAR T-cell therapies that could work against solid tumor cancers,” Bachanova said. “It’s a huge challenge because solid cancers are very different from blood cancers, but we’re seeing results that suggest this strategy may be beneficial for patients with solid tumor cancers for whom chemotherapy is not effective.”

The University of Minnesota is contributing to this research. Our patients may be eligible to participate in clinical trials for colon cancer, non-small cell lung cancer, and ovarian cancer. Talk to your care team if you’re interested, or learn more about participating in clinical trials.

How does CAR T-cell therapy work?

T-cells are a key part of your immune system. They are tasked with recognizing and destroying intruders, including cancer calls. Some cancer cells carry abnormal proteins called antigens on the surface of the cell. When certain T-cells recognize these abnormal proteins, they use receptors to grab onto the cancer cell and destroy it.

CAR T-cell therapy takes your own T-cells and adds the information they need to identify your cancer and destroy it. Once your T-cells are reprogrammed and infused back into your body, they multiply to create even more cancer-destroying cells.

“We call them serial killers,” Bachanova said, “because it’s a one-to-one killing. They go into the tumor sites, and they fight with the cancer cells to eliminate them.”

What should a patient expect?

One benefit of CAR T-cell therapy is that it only requires one infusion treatment and a month of monitoring.

“Unlike other therapies, like chemotherapy, in which you may have many cycles, CAR T-cell therapy is a one-time treatment without any therapy following it,” Bachanova said. “Each patient is closely monitored for a month or more after getting a CAR T-cell infusion.”

The process begins with white blood cell collection. It can take several hours of lying down while a machine collects your blood and separates out your white blood cells. After this, you can typically return home while your cells are modified – or turned into CAR T-cells in a lab. This can take a few weeks.

When your T-cells are ready, you’ll need to return to the clinic and prepare to stay within 30 minutes of the M Health Fairview Clinics and Surgery Center in Minneapolis for a month. You may have a few rounds of chemotherapy to prepare your body. Then your CAR T-cells will be infused.

It’s common to have a reaction to the infusion that can include low blood counts, fast heart rate, low blood pressure, or neurological effects like confusion. So most patients stay in the hospital for about a week for monitoring. 

After you leave the hospital, you’ll need a caretaker with you for the next month or two as you recover. You cannot drive or operate heavy machinery during this period. Most people need a break from work, school, or other commitments as well.

What are the side effects?

Because CAR T-cells ramp up the immune system, people are at risk of a condition called cytokine release syndrome. It can cause flu-like symptoms including:

These effects usually clear within a couple of weeks. Some people could have an allergic reaction to the infusion, low levels of electrolytes (potassium, sodium, and phosphorous) in the blood, and low blood cell counts. Neurological symptoms, such as confusion can also occur.  Your health care team will monitor you closely after your infusion.

What’s next for CAR T-cell therapy?

Early clinical trials are suggesting that CAR T-cell therapy could be beneficial for more cancers in the future. Right now, the procedure is considered when chemotherapy fails. But Bachanova believes that CAR T-cell therapy could eventually replace chemotherapy.

“Minnesota is on a cutting edge of this research in both the lab and clinic,” Bachanova said. “Patients here have access to some of the most innovative ways to treat cancer as a result of the clinical experience we’ve already attained.”