The promise of CAR T-cell therapy in the fight against cancer

AsianScientist (September 30, 2024) – The landscape of medical science continues to advance. New treatments are being researched and introduced rapidly, including for some of the most complex diseases such as diffuse large B-cell lymphoma (DLBCL), a type of aggressive blood cancer. Typically, standard treatment for relapsed or refractory DLBCL includes a range of intensive treatments, including chemotherapy and hematopoietic stem cell transplantation. More recently, through extensive research and development, chimeric antigen receptor (CAR) T cell therapy has emerged as a promising new treatment option, providing a more effective alternative for those for whom conventional treatments have proven inadequate.

CAR T-cell therapy uses the body's own immune cells to attack and eliminate cancer cells. In this personalized approach, a patient's T cells are modified in a laboratory to more effectively recognize and target attacking cancer cells. In contrast to the one-size-fits-all approach of traditional cancer treatments, CAR T-cell therapy is a prime example of precision medicine and has a level of specificity that has been shown to improve outcomes in patients with relapsed or refractory large B-cell lymphoma.

When CAR T-cell therapy is used early in treatment, it can potentially change the course of DLBCL patients for the better. A key study has shown that patients who receive CAR T-cell therapy as a second-line treatment – ​​rather than waiting for a third-line or later option – often require fewer follow-up interventions. This not only improves the patient's quality of life, but also reduces the overall burden on healthcare systems by streamlining treatment pathways.

“It is important that therapies that have been proven to improve overall survival in second-line treatment, such as: “Axicabtagene ciloleucel (Axi-Cel) should not be postponed to later lines of treatment,” said Professor Mickey Koh, Clinical Director of Oncology and Hematology at St. George's University Hospital, London, United Kingdom. “This timing may be crucial for many patients whose clinical condition may unfortunately deteriorate or become too frail to receive further intensive therapies needed for a cure.”

As the adoption of CAR T-cell therapies gradually advances, it is important to understand that this is not everything
CAR T-cell treatments are equivalent. Each therapy has unique characteristics, efficacy rates, and safety profiles that can vary significantly depending on the patient's specific type of lymphoma, their overall health, and the stage of their disease.

“The right decision for CAR T-cell therapy depends on several factors, including response rates, toxicity profile and clinical experience with use in individual treatment centers. In urgent cases where the urgency of treatment is paramount and time is of the essence, a product known for its quick turnaround time and reliable manufacturing process would be the preferred choice. Ultimately, physicians must weigh many factors to make an informed decision when selecting the most appropriate CAR T-cell product for their patients,” added Prof. Koh.

Access to more than one CAR T-cell therapy provides flexibility in patient care – helping to mitigate supply issues and provide alternative options when a particular therapy is not appropriate for a patient's condition. This variety of treatment options ensures that each patient receives the care best tailored to their specific needs.

Currently, three CAR T-cell therapies – axi-cel, tisagenlecleucel (tisa-cel), and lisocabtagene maraleucel (liso-cel) – have received approval in various countries for the treatment of adult patients with DLBCL. These therapies can be used in either second- and/or third-line therapy in adult patients with relapsed or refractory DLBCL, depending on the approved indication in the country. The results of these therapies remain promising: A clinical trial of Axi-Cel showed that patients with DLBCL who received treatment were 2.5 times more likely to survive after two years without it compared to patients who did not receive the treatment disease progression or the need for additional cancer treatment to be alive standard of care.

Although CAR T-cell therapy is promising, accessibility remains the core challenge. The complex manufacturing process, high cost and limited number of qualified treatment centers mean that not all eligible patients have easy access to this therapy. Many living in regions with less developed health infrastructure must travel to specialized centers, which can be burdensome in itself.

Despite cost issues, clinical data have shown that CAR T-cell therapies have resulted in significantly better response rates and survival outcomes in patients with large B-cell lymphoma – particularly in second-, third-, or late-line therapy.

“These results highlight the transformative potential of CAR T-cell therapy in improving patient outcomes and provide a significant advantage over previously available standard treatment options,” said Prof. Koh.

This article is supported by Gilead and Kite Oncology.

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Source: Gilead and Kite Oncology; Image: Unsplash

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