“CAR T Cell Therapy: Transforming Cancer Care Through Immunotherapy Advancements”
For many years, cancer treatment has relied on surgery, chemotherapy, and radiation therapy as its fundamental pillars. While these remain crucial cornerstones, the landscape of cancer treatment has witnessed a transformative shift with the emergence of novel treatment categories, offering new hope and possibilities for individuals battling cancer.
The 2000s witnessed the rise of targeted therapies such as imatinib (Gleevec) and trastuzumab (Herceptin). These medications locate and eliminate cancer cells by targeting specific molecular alterations predominantly found within those cells. Today, numerous targeted therapies have become standard treatments for various cancers.
Moreover, in the last decade, immunotherapy has surged as what many now term the “fifth pillar” of cancer treatment. Immunotherapies harness and enhance the body’s immune system to combat tumors. These drugs have demonstrated remarkable potential, capable of reducing or even eradicating tumors in some individuals with advanced cancer. In a small subset of patients, these treatment responses have proven to be long-lasting, spanning several years.
Immune checkpoint inhibitors, a class of drugs, are extensively employed in treating various cancers like melanoma, lung, kidney, bladder, and lymphoma. Meanwhile, another form of immunotherapy, known as CAR T-cell therapy, has sparked significant enthusiasm among researchers and oncologists.
Although not as broadly utilized as immune checkpoint inhibitors, CAR T-cell therapies have demonstrated comparable efficacy in eliminating highly advanced leukemias and lymphomas. Moreover, they exhibit the capacity to sustain remission for numerous years.
What diseases can be cured with the aid of CAR T cell therapy? CAR T treatment can fight against certain types of cancer, even as the other treatments employed are not working.
CAR T therapy is already FDA-approved to treat several issues including Leukemia, Lymphoma, and Multiple Myeloma.
CAR T cell therapy operates by modifying T cells, a type of white blood cell integral to detecting and combating illness and infection within the body. Typically, T cells possess receptors that identify antigens, which are proteins or molecules recognizable by the immune system. When foreign or abnormal antigens are identified, the immune system mobilizes to eliminate them.
However, cancer cells sometimes exhibit antigens that the body doesn’t flag as abnormal. Consequently, the immune system might not dispatch T cells to combat these cancerous cells. In other scenarios, the T cells may struggle to clear the cancer cells effectively.
Chimeric antigen receptor T cells (CAR T cells) undergo genetic modification within a laboratory setting. This process introduces a novel receptor, enabling these cells to bind to cancer cells and induce their destruction.
Notably, various cancers possess distinct antigens. Accordingly, each CAR T cell therapy is tailored to target a specific cancer antigen. Thus, a CAR T cell therapy designed for one type of cancer will not be effective against a different type of cancer.
CAR T-cell therapies have been around since 2017, when the FDA approved of its use, the only criticism about this form of treatment, is that it comes at a high cost. Approved CAR T-cell therapy costs around $450,000. Because of how effective it is in improving the lives of patients. It has become widely accessible in the United States and European countries. It is now used as a standard protocol treatment for aggressive lymphomas. It is now an official part of modern medicine.
Understanding The CAR T-cell Therapy Process:
CAR T cell therapy is an intricate process that can only be done by experts
The process takes a few weeks, and the steps generally include:
- Collecting the T Cells: blood is drawn from a vein in the arm. The blood flows through a tube into an apheresis machine, which removes the T. Cells. The machine then returns the rest of the blood back into the body using a different tube.
- Engineered T Cells: in the laboratory, scientists engineer the T cells by including a manufactured CAR. Then the lab allows the CAR T cells to grow and multiply.
- Infusing the CAR T Cells: Once the lab has ample CAR T cells, it is now injected back into the patient's arms. Some healthcare teams or clinics will recommend chemotherapy before taking the CAR T cell infusion to increase the effectiveness of the procedure.
Side effects or complications might arise from CAR T cell therapy.
One significant complication is cytokine release syndrome (CRS), a severe outcome of CAR T cell therapy. It occurs when CAR T cells release cytokines, triggering an immune system response.
Symptoms may encompass:
- Fever and chills
- Dizziness, lightheadedness, or headaches
- Muscle or joint pain
- Nausea, vomiting, or diarrhea
- Rapid heartbeat
- Low blood pressure
- Difficulty breathing
- Abnormal levels of essential minerals in the blood
- Allergic reactions
- Increased susceptibility to infections, bruising, or bleeding
After receiving CAR T-cells, the usual protocol involves a hospital stay spanning about a week to 10 days. This duration allows healthcare providers to closely observe your response to the treatment and promptly address any side effects. In some cases, it might be possible for individuals to receive CAR T-cells without an extended hospital stay. However, even in such instances, healthcare providers will continuously monitor patients' progress and oversee the procedure. If any side effects arise, a return to the hospital might be necessary to ensure the completion of the treatment.
The Foundation of CAR T Therapy Process
Essentially, T cells, integral to orchestrating the immune response and directly eliminating infected cells, serve as the foundation of CAR T-cell therapy.
The current CAR T-cell therapies are tailored to each patient, crafted by harvesting their T cells and then modifying them within a laboratory setting. This process involves engineering these cells to express chimeric antigen receptors (CARs) on their surface. These CARs are designed to identify and attach to specific proteins, known as antigens, present on the surface of cancer cells.
CAR T cell therapy isn’t solely reserved as a final resort for cancer treatment.
In the realm of non-Hodgkin lymphoma (NHL), recent clinical trials have indicated that CAR T cell therapy might outperform standard treatments. Typically, CAR T-cell therapy hasn’t been considered until a person’s cancer has worsened despite multiple prior treatments. However, this perspective is evolving.
Notably, in two significant clinical trials, CAR T-cell therapy exhibited superior efficacy compared to standard treatments for patients with non-Hodgkin lymphoma whose cancer resurfaced following their initial chemotherapy — the first-line treatment. This breakthrough led experts to contemplate the possibility of CAR T-cell therapy replacing chemotherapy as the standard second-line treatment for these patients.
Dr. Fry highlighted the potential benefits of utilizing CAR T cells for some children with acute lymphoblastic leukemia (ALL), particularly those at high risk of disease recurrence after initial chemotherapy. Ongoing small-scale clinical trials explore the application of CAR T cells in children with ALL who exhibit suboptimal responses to their initial chemotherapy regimen.
In cases where patients respond positively to CAR T-cell therapy, Dr. Fry emphasized the remarkable prospect of sparing them an additional two years of chemotherapy. This potential paradigm shift represents a promising advancement in cancer treatment strategies.
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