'A Deep and Durable Response'
- CAR T-cell therapy is a one-time treatment that is both a drug and procedure.
- A patient’s immune system’s T cells are extracted from their body, genetically modified in a lab to identify and attack cancer cells, and then put back into the body to do their work.
- “This is a one time treatment that we know can have very deep and durable responses for patients. If you ask any myeloma patient, he or she will tell you that they want to be off therapy and that’s what cellular therapy can really do. So we’re very excited to be a part of this,” Dr. Nina Shah, Global Head of Multiple Myeloma Clinical Development and Strategy at AstraZeneca, tells SurvivorNet.
CAR T-cell therapy is a one-time treatment that is both a drug and procedure. A patient’s immune system’s T cells are extracted from their body, genetically modified in a lab to identify and attack cancer cells, and then put back into the body to do their work.
Read MoreWhat is CAR T-Cell Therapy?
For multiple myeloma, CAR T-cell therapy most commonly targets the “B-cell maturation antigen,” or “BCMA.” “One of the nice advantages is that, so far, CAR T is a one-and-done therapy,” Dr. Robert Orlowski, chairman, ad interim, and director of myeloma at MD Anderson Cancer Center, told SurvivorNet in a previous conversation.“When the CAR Ts are reinfused, you don’t have any additional chemotherapy afterward … and many of these patients who were quite sick at the beginning feel better after this than after any prior therapy they’ve had.”
Plus, he says, “if people have a great response, [their quality of life] is much better, it seems, than with standard chemotherapies.”
How Does it Work?
The way the therapy works is by using the body’s immune system to destroy cancerous cells. The immune system’s main soldier in fighting off viruses and bacteria is the T-cell. Unfortunately, the body’s T-cells aren’t typically strong enough to fight off myeloma cells, but scientists have recently been able to extract T-cells from a patient’s body, modify them, and then reinsert them back into the patient.
The entire process involved in getting CAR T-cell therapy can take a few weeks.
- The first step is drawing blood and separating out the T cells.
- Then, using a virus that’s been modified to be harmless, the T cells are genetically engineered to produce proteins called chimeric antigen receptors (CARs) on their surface. These receptors will enable the cells to recognize and attach to a matching protein, called an antigen, on the tumor cell just as a key fits into a lock. The process primes the T cell to “recognize the cancer and to fight it.”
- Next, the modified cells are multiplied into the millions in a laboratory. Many are needed to fight cancer.
The CAR T cells are specific to the patient’s cancer. For example, some types of lymphoma cells have the antigen CD19 on their surface. CAR T-cell therapies for those cancer types only target the CD19 antigen.
A few days before the actual infusion, the patient gets chemotherapy to clear out some of their own immune cells and prime their body to receive the CAR T cells. This will help the CAR T cells work better. Finally, the modified T cells will be infused back into the body to hunt down the cancer.
“One of the great things about cellular therapy that we’re learning is that it’s actually very effective in late lines of therapy and in more earlier lines. And not only that, it’s actually very well tolerated,” adds Dr. Shah.
“We know that cell therapy is a very effective therapy, but not necessarily all patients can get it. And that’s something that we really want to address, particularly with our FAST CAR-T manufacturing platform, which decreases the time of manufacturing and thereby will theoretically increase our capability to give more cell therapy products to more people,” explains Dr. Shah.
Currently, two BCMA-directed CAR-T cell therapies are FDA approved:
About Abecma
Progression-free survival was three times better for patients who received Abecma (Idecabtagene vicleucel) instead of the standard treatment. That means that people who received Abecma lived three times longer without multiple myeloma coming back or getting worse compared with standard (13.8 months vs 4.4 months)
Progression-free survival is the amount of time a person was alive and without the cancer getting worse after treatment. People in the clinical study were followed for 30.9 months.
About Carvykti
For patients receiving Carvykti, there was a 59% reduction in the risk of patients dying or relapsed/refractory multiple myeloma getting worse compared to standard therapy combinations.
- After one year: Three-quarters of patients (76%) who took Carvykti were living without their disease worsening compared to 50% who took one of two standard therapy combinations.
- The Overall Response Rate (ORR) with Carvykti was 85%. ORR is the percentage of patients who have any kind of response to multiple myeloma treatment.
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