The Power of CAR T-Cell Therapy in Cancer Treatment
Introduction
When Doug Olson was diagnosed with chronic lymphocytic leukemia (CLL) in 1996, his journey through cancer treatment began. Initially advised to observe the slow-growing cancer, Olson eventually had to undergo chemotherapy as the disease progressed. However, in 2009, traditional treatments failed as the tumor changed, leading to a recommendation for a bone marrow transplant, which proved challenging due to a lack of suitable donors within Olson’s family.
Understanding CAR T-Cell Therapy
Amidst the challenging times, Olson’s doctor suggested a cutting-edge treatment option – CAR T-cell therapy. This innovative form of immunotherapy involves redesigning the patient’s immune cells in the lab to specifically target and destroy cancer cells. Unlike traditional treatments like chemotherapy, which can harm healthy cells along with cancerous ones, CAR T-cell therapy offers a more precise and targeted approach.
How CAR T-Cell Therapy Works
During CAR T-cell therapy, T cells are extracted from the patient’s body and engineered to produce chimeric antigen receptors (CARs) on their surface. These CARs enable the modified T cells to identify and attack cancer cells more effectively. Once these engineered cells are reintroduced into the patient’s body, they are primed to seek out and destroy cancerous cells.
The Success of CAR T-Cell Therapy
CAR T-cell therapy has shown remarkable success in treating certain types of blood cancers, with remission rates reaching as high as 90%. In cases where other treatments have failed, CAR T-cell therapy has offered a new lifeline to patients like Olson, who saw almost miraculous results with the eradication of cancer cells from their bodies.
Current and Future Landscape of CAR T-Cell Therapy
With the FDA approving CAR T-cell therapies like Axicabtagene ciloleucel (Yescarta) and Tisagenlecleucel (Kymriah) for specific types of cancer, the field of immunotherapy is rapidly evolving. Researchers like Dr. Renier Brentjens are actively exploring ways to broaden the application of CAR T-cell therapy to treat solid tumors and improve long-term outcomes for patients.
Unique Insights on CAR T-Cell Therapy
Despite the promising results of CAR T-cell therapy, challenges remain, including the potential for cancer recurrence and side effects like cytokine release syndrome. Additionally, the long-term effects and sustainability of CAR T-cell responses are areas of ongoing research and development in the field of cancer treatment.
Expanding Horizons in Cancer Treatment
Looking ahead, the future of CAR T-cell therapy holds immense potential for revolutionizing cancer treatment. As researchers continue to refine and expand upon this innovative approach, there is hope for a broader range of cancers to be effectively targeted and treated using CAR T-cell therapy.
Summary
In conclusion, CAR T-cell therapy stands as a beacon of hope in the realm of cancer treatment, offering personalized and targeted solutions for patients facing challenging diagnoses. With ongoing advancements and research in the field, the potential of CAR T-cell therapy to transform the landscape of cancer care is truly remarkable.
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In 1996, Doug Olson learned he had chronic lymphocytic leukemia (CLL), a type of cancer that begins in the white blood cells. This cancer usually grows slowly, so his doctor decided to observe it and wait to treat it.
But when Olson’s cancer began to grow a few years later, she had to undergo several rounds of chemotherapy. Then in 2009, the tumor changed. Chemotherapy no longer helped. Olson’s doctor, David Porter, MD, recommended a bone marrow transplant. But none of Olson’s brothers were a good match.
“It seemed like the news was getting worse,” Olson says.
Olson’s doctor then suggested conducting a clinical trial for a new type of cancer treatment. Specifically, it was a type of immunotherapy called CAR T-cell therapy. The goal: redesign Olson’s immune cells in the lab into weapons to hunt cancer cells.
CAR T cell therapy may work when other treatments have not. And unlike chemotherapy and radiation, which kill both healthy and cancerous cells, immunotherapy targets tumors more precisely.
CAR T cell therapy, or CAR T, is one of the few types of immunotherapy. Each one works in a different way.
Doctors may turn to CAR T when T cells, which normally patrol the bloodstream to detect germs and other invaders, cannot recognize cancer as a foreign cell. That happens if the T cells lack specific proteins that can bind to the tumor to attack.
It’s as if “the cancer cell has a piece of Velcro, but the patient’s T cells don’t have a corresponding piece of Velcro to stick to,” says Porter, director of the Cell Therapy and Transplantation Program at the University of Pennsylvania.
During CAR T-cell therapy, doctors first remove T cells from the body. They then add a gene that causes T cells to produce special proteins called CARs (chimeric antigen receptors) on their surface, which can attach to cancer cells. After CAR T cells grow in the lab, doctors return them to the body.
The redesigned T cells “have been trained to recognize and kill tumor cells,” says Renier Brentjens, MD, PhD, professor of medicine and director of the Cell Therapy Service at Memorial Sloan Kettering Cancer Center.
Not only that, T cells “expand between 1,000 and 10,000 times in the body. And each of those cells can kill more cancer cells,” Porter says.
Olson received three doses of CAR T cells. After a couple of weeks, almost 20% of her white blood cells were CAR T. When she returned to Porter for testing, “he told me they couldn’t find a single cancer cell in my body,” Olson recalls.
The FDA approved the first CAR T-cell therapy in 2017. To date, the agency has approved two CAR T-cell therapies for cancer.
Axicabtagene ciloleucel (Yescarta). It is approved for B-cell lymphoma in adults that has not responded to other treatments or has returned after treatment.
Tisagenlecleucel (Kymriah). It has the same approval as axicabtagene ciloleucel, but can also be used to treat children and young adults with acute lymphoblastic leukemia.
In studies, 9 out of 10 people with acute lymphoblastic leukemia whose cancer did not respond to other treatments or whose cancer came back had a complete remission with CAR T-cell therapy. Remission means that the cancer cannot be found on tests.
Complete remission rates for chronic lymphocytic leukemia and non-Hodgkin lymphoma are lower: 35 to 70 percent. Of that number, about a third have long-lasting remissions. “For those people, it absolutely lives up to the promise,” Porter says.
But the problem is that remissions are not always permanent, Brentjens says. In many cases, doctors don’t know why the cancer comes back. It could be that CAR T cells do not last long in the body. Or they may eventually be overtaken by a group of T cells that do not have the protein that can fight cancer.
You will not suffer from the hair loss that often occurs after chemotherapy. In contrast, CAR T cell therapy can cause a brief but serious reaction called cytokine release syndrome, or CRS.
“It’s similar to having a horrible case of the flu,” says Terry Fry, MD, a cancer researcher and professor at Children’s Hospital Colorado.
Cytokines are proteins that immune cells release when they attack an infection. Symptoms include high fever, nausea, chills, headache, rash, and difficulty breathing. CRS can be fatal, but it can be treated in a hospital.
CAR T cell therapy can also affect the brain, causing confusion, slurred speech, and sometimes seizures. Typically, Fry says, those symptoms appear a couple of weeks after the infusion and improve in about a month.
It has been less than a decade since the first person received CAR T-cell therapy. Therefore, doctors do not yet know the long-term risks.
CAR T cell therapy works for blood cancers. But so far it has not been able to treat solid tumors such as breast or lung cancer.
Leukemia and lymphoma cells are easier to detect because the target protein is on the surface and because they are not found on healthy cells.
Fry says that “solid tumors are a harder bone to crack” because it is harder to distinguish between specific proteins found in cancerous tumors and those found in healthy tissue.
Brentjens is one of the researchers looking for ways to get around this and other obstacles.
“I’m an optimist, so I would say that in the next 5 to 10 years we might have some CAR T cells that could attack some solid tumors,” he says. “But this is still a work in progress.” “.
Although there is still work to be done, CAR T-cell therapy has been a life-saving treatment for many of the people who have received it. “A significant proportion of patients treated with these CAR T cells will survive long-term. And the patients we are treating are those whose survival prospects were slim to none,” Brentjens says.
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