Is Age a Barrier to CAR T-cell Therapy?
- CAR T-cell therapy is a type of immune treatment that essentially trains your own cells to target your cancer.
- Age is a concern worth considering with any treatment for multiple myeloma, which typically affects people over age 65.
- Studies find CAR T-cell therapy safe and effective in older adults.
- However, people should have good heart and lung function before they undergo this treatment.
Chimeric antigen receptor (CAR) T-cell therapy is a relatively new approach to treating multiple myeloma that hasn't responded to other treatments, or that has come back after treatment. It works by removing your own immune cells, called T cells, and altering them in a lab to help them more effectively and precisely target your cancer. There are certain considerations about which patients can receive this and other immunotherapies, but age shouldn't be one of them.
Read MoreCAR T-Cell Therapy in Older Adults
Most people who are diagnosed with multiple myeloma are age 65 or older. And because CAR T-cell therapy has become an important tool in the treatment of people with relapsed or refractory (not responsive to treatment) forms of this blood cancer, it's worthwhile to consider whether age affects its safety or success. So far, it looks like age isn't a concern."The oldest CAR T patient that I’ve taken through is 78 years old. And she went through it better and faster than a lot of the younger patients, which I was pretty amazed at," Dr. Martin says.
Related: When CAR T-Cell Therapy Isn't Right for You
A 2020 study published in the journal Blood evaluated the safety and effectiveness of the CAR T-cell therapy idecabtagene vicleucel (Abecma). The researchers found that people age 65 and older had similar response and survival rates as younger people. The treatment was both safe and effective against their cancer.
Safer Than a Stem Cell Transplant?
Because CAR T-cell therapy is done in a hospital where doctors and nurses can closely monitor you afterward, it may actually be a safer option than an autologous stem cell transplant for older adults, according to Dr. Martin.
A stem cell transplant involves getting high doses of chemotherapy, followed by an infusion of your own healthy stem cells. It's an intensive and risky process, which is why it generally isn't recommended for people over age 65. Dr. Martin said his 78-year-old patient who received CAR T-cell therapy wouldn't have qualified for a stem cell transplant.
He believes that CAR T-cell therapy and other immunotherapies could eventually replace stem cell transplants, and will be a good option for people at any stage of life. "I think the people that are going to be eligible for these therapeutics are people that are in good shape, without an age limit," he says.
Who Is An Ideal Candidate?
CAR T-cell therapy may be safer for older people than a stem cell transplant, but it does come with its own set of risks. The infusion of immune cells can set off a reaction called cytokine release syndrome (CRS), which produces symptoms such as a high fever, chills and difficulty breathing. CAR T-cell therapy can also affect the brain, sometimes leading to confusion and difficulty speaking or understanding.
Related: CAR T-Cell Therapy: What You Should Know About Side Effects
To ensure that this treatment is done as safely as possible, it's critical for doctors to choose patients carefully. Good heart and lung function are essential, Dr. Martin says. "So if you’re on oxygen, then it’s unfortunately not going to be possible to do CAR T-cell therapy."
But for most reasonably healthy older adults, this treatment is feasible. As a test, he asks his patients if they are able to go outside and walk the length of a few telephone poles. "If they say 'Yes,' then most of those patients are going to be eligible to do these therapeutics," he says.
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