Judy Wilkins tried four different chemotherapy regiments over 18 grueling months to try to put her lymphoma into remission. Her team never could. But thanks to CAR T-cell therapy, an emerging immunotherapy treatment that is showing great promise in clinical trials nationwide, Wilkins is cancer-free.
CAR (Chimeric Antigen Receptor) T-cell therapy is a form of cellular therapy that uses a patient’s own immune system cells to rally an attack on cancer. T cells, white blood cells which are programmed to kill cancer cells but don’t always recognize them, are removed from the patient’s blood and engineered to sprout special structures called chimeric antigen receptors (CARs) on their surface. When re-infused into the patient, these CAR T-cells can be particularly adept at identifying and killing cancer cells.
As of May 2018, CAR T-cell therapy has been approved by the U.S. Food and Drug Administration as standard therapy for some adult patients with aggressive non-Hodgkin lymphoma that has relapsed after prior treatments, or has not responded to other therapies (refractory), and for patients age 25 and under with relapsed or refractory B-cell acute lymphoblastic leukemia.
As of September 2017, nearly 70 percent of the patients on the CAR T-cell trial for diffuse large B-cell lymphoma have achieved a positive response. Fifty percent – like Wilkins – have seen a complete remission.
“These are phenomenal numbers, and are consistent with similar trials for this and other lymphoma types going on around the country,” says Caron Jacobson, MD, Wilkins’ oncologist and principal investigator for the Dana-Farber trial. “Standard chemotherapy will be effective for many patients, but not all of them. If we can identify those patients who do not respond well, and may be strong candidates for CAR T-cell therapy, we might spare them months of ineffective chemotherapy.”
It could also prevent some patients from undergoing a donor-based stem cell transplant, an intensive procedure that Jacobson originally envisioned for Wilkins if her lymphoma responded to treatment. A transplant requires a long hospital stay, many months in isolation at home, and approximately a year away from work. Wilkins, who has owned her own beauty salon for 30 years, was in the hospital less than 10 days after her CAR T-cell therapy, and back to her salon in six weeks.
“Every three months I go back for PET scans and bloodwork, but I feel terrific,” says Wilkens, the mother of two grown children. “I really lucked out that I was under the care of Dr. Jacobson, who had done the work needed to start this trial and had a spot for me right when I needed it.”
Still, it’s too early to know if this approach will be a cure for patients like Wilkins, says Jacobson. There are also post-infusion side effects, including cytokine release syndrome, which can cause high fevers, low blood pressure, and respiratory and other organ problems – but these usually go away after a few days.
Still, the promise of CAR T-cell therapy remains very encouraging. Currently, there is a clinical study underway at Dana-Farber for patients with sarcomas. Other solid-tumor cancers, including ovarian cancer, brain tumors, prostate cancer, and melanoma, are also being researched elsewhere.
“This is revolutionary,” says Jacobson. “We’re doing things for people who really had no other options a year and a half ago.”
Judy Wilkins knows she is one of them. And with her own hair now grown back, she’s back to cutting it off others with a smile and hope for her future.