Treatments for cancer are constantly evolving, giving patients hope in the fight against deadly diseases. For patients with some blood cancers, there is a treatment being used called Chimeric Antigen Receptor T-cell therapy, or CAR T-cell therapy.
How it works
The body’s immune system is remarkable in its ability. One of the components of the immune system that does this excellent work is a subset of white blood cells called T lymphocytes.
“If a patient has a certain type of blood cancer, what we can do is draw some of the patient’s blood and manufacture agents to attach to the patient’s T-cells,” said Dr. Seth Fagbemi, hematologist and oncologist at Marshfield Clinic Health System. “Once we’ve done our work in manipulating the patient’s blood, we infuse that blood back into the patient. Those T-cells that have now been made particularly effective and efficient will go and attack the cancer cells that are in the patient.”
CAR T-cell therapy process
The process looks similar to a blood transplant in the sense that blood is used. The difference is that the blood is manipulated by a manufacturer, whereas in typical transplantation, blood is collected and then directly given to somebody else or back to the patient.
Manipulating the patient’s blood can take a few weeks depending on the manufacturer. There are several companies doing this type of work. It’s not available off the shelf, so there is a delay in getting the finished blood back to the patient.
“One of the things that we hope will happen in the future is to have these cells already available, so that if somebody says, ‘Oh you need CAR-T, we just write the prescription and boom, they have it,’” said Dr. Fagbemi. “In that case, the blood wouldn’t come from the patient, it’d be from somebody else. But we’re not there yet, so it takes time.”
If a patient is deemed to be somebody that will benefit from CAR T-cell therapy, they begin with a process called apheresis. The patient is hooked up to a machine that looks like a dialysis machine. Their blood is run through the machine and T-cells are collected over a period of a couple hours.
The patient’s T-cells are then shipped to the manufacturer. The product is manipulated and returned to the provider, and the blood is then infused back into the patient. That process takes maybe an hour, similar to a normal blood transfusion.
The future of the treatment
Currently, this therapy is only approved for blood cancers, lymphomas and leukemias. Right now, patients are only using CAR T-cell therapy once. The goal is that the patient gets a complete response to their blood cancer and never needs to be treated again.
“It’s an extremely exciting time to be in this field,” Dr. Fagbemi said. “We’ve been talking about CAR T-cell therapy for almost 10 years from the very, very beginning and in the last six years, the treatment has become more popular. “
CAR T-cell therapy is not the first option yet and there are many reasons why. Cost is part of it, along with finding an experienced health care organization to provide it. CAR T-cell therapy is also not the last option anymore.
“One of the more exciting developments is that we can use CAR T-cell therapy earlier than we have been,” Dr. Fagbemi said. “A few years ago, it would be reserved for people who may not have any other option left. Now we’re using it earlier and earlier with good results. It’s enough to be able to add it in as another item on the menu, so to speak.