CAR T-cell therapy, like all forms of cancer immunotherapy, seeks to sharpen and strengthen the immune system’s inherent cancer-fighting powers. It involves treating patients with modified versions of their own immune system T cells – white blood cells that help protect the body from disease. The groundbreaking therapy recently became the first of its kind approved by the U.S. Food and Drug Administration (FDA) to treat a form of cancer in adults — specifically, patients with relapsed or refractory aggressive non-Hodgkin lymphoma (NHL).
“This is an important and exciting advance,” said Caron A. Jacobson, MD, Medical Director of the Immune Effector Cell Therapy program at Dana-Farber/Brigham and Women’s Cancer Center (DF/BWCC). “It opens up a new treatment for a group of patients who really needed another option.”
The approval of the drug, known as Yescarta, followed the FDA’s first-ever approval in August, 2017, of CAR T-cell therapy for pediatric and young adult patients with B-cell acute lymphoblastic leukemia (ALL) who have relapsed or haven’t responded to previous treatments.
Jacobson answered questions about the new treatment during a Dana-Farber Facebook Live chat. Highlights include:
- Yescarta is for patients with aggressive NHL that has relapsed after or not responded to at least two prior lines of treatment. Without CAR T-cell therapy, these patients would otherwise be referred to clinical trials or other therapies that have a 20 to 30 percent chance of eliciting a response, according to Jacobson. “The purpose of clinical research for many years has been to try and find new drugs to help these patients – and there are certainly some that have been developed,” Jacobson said. “None have had the success that CAR T-cell therapy has had for these patients.”
- CAR T-cell therapy has the potential to cause a host of side effects, including cytokine release syndrome (CRS) and neurotoxicity in some patients. CRS can cause dangerously high fevers, extreme fatigue, difficulty breathing, and a sharp drop in blood pressure. Neurotoxicity, on the other hand, can result in side effects as mild as confusion, but can be much more severe — some patients have had difficulty with speaking and language, despite being alert, according to Jacobson. Neurotoxicity usually starts around six days after treatment, persists for three to 10 days, and then starts to improve. Other general side effects can include tremors, headaches, loss of balance, trouble speaking, seizures, and sometimes hallucinations.
- Researchers are still determining whether CAR T-cell therapy can be used earlier in some patients with lymphoma. Chemotherapy is still the main type of treatment for lymphoma – it’s highly effective and has well-known, and generally well-managed side effects, Jacobson said. But if a patient is likely to fail on a second round of chemotherapy, should they be treated with CAR T-cell therapy first? “Right now, we’re not there,” Jacobson said. However, an upcoming clinical trial that will be available at DF/BWCC will compare patients who receive CAR T-cell therapy after their first line of chemotherapy versus patients who move forward with a second line of chemotherapy as well as a possible autologous stem cell transplant.
View a recording of the full Facebook Q&A here: