CAR T-cell Therapy 101: Latest Treatment At PCC

Contributed by: Dr Lee Yuh Shan

A new cancer treatment is making waves for its impressive breakthroughs in the treatment of haematological malignancies. In this issue of HealthNews, we take a look at the basics of CAR T-cell Therapy and how patients will benefit.

  1. What is CAR T-cell Therapy?

  2. Chimeric Antigen Receptor (CAR) T-cell Therapy is a form of immunotherapy where T-cells are taken from the patient’s blood and modified in a laboratory setting to enable the T-cells to identify and destroy specific cancer cells. The modified T-cells are then reinfused into the patient.

    Once back inside the patient’s body, the modified T-cells will be able to detect the cancer cells and destroy the cancer by harnessing the body’s own immune response.

    Singapore is the first country in Southeast Asia to offer the treatment.

    DID YOU KNOW?

    T-cells or T-lymphocytes are a type of white blood cells in our immune system. T-cells have the capacity to recognise abnormal cells or any cells infected by viruses in the body, and then destroy these abnormal cells.

    However, T-cells may sometimes fail to recognise or eliminate these threats in the body, such as in the case of cancer.

    Chimeric Antigen Receptor (CAR)
    Reprogrammed T-cell
    Cancerous B-cell

  3. What conditions can it treat?

  4. CAR T-cell Therapy is particularly effective for patients diagnosed with relapsed aggressive forms of Acute Lymphoblastic Leukemia (ALL) and relapse of Non-Hodgkin Lymphoma such as Diffuse Large B-cell Lymphoma (DLBCL), especially when at least two prior treatment regimens have failed to produce the desired outcomes.

  5. Who is eligible?

    • Children and young adult patients from 2–25 years old with B-cell ALL that is resistant, and where a relapse has occurred subsequently or post-transplant.
    • Adults with DLBCL who have not benefited from at least two types of standard treatment.

    The following groups of patients may not be eligible for CAR T-cell Therapy:

    • Patients with intracranial hypertension or unconsciousness
    • Patients with respiratory failure
    • Patients with disseminated intravascular coagulation
    • Patients with hematosepsis or uncontrolled active infection

  6. What are the side effects?

  7. One common side effect of CAR T-cell Therapy is Cytokine Release Syndrome (CRS), which is a multisystemic disease resulting from the effects of CAR T-cells at work and elimination of cancer cells.

    Side effects of CRS include:

    • High fever and chills
    • Difficulty breathing
    • Nausea, vomiting and/or diarrhoea
    • Feeling dizzy and lightheaded
    • Headaches
    • Fast heartbeat
    • Fatigue
    • Muscle and/or joint pain

    CRS can develop many weeks after infusion, but most commonly develop within two weeks after infusion. The severity of CRS is not correlated with the response to CAR T-cell Therapy.

    Another common side effect is immune effector cell-associated neurotoxicity syndrome (ICANS), which affects the central nervous system of the patient.

    CRS and ICANS are well recognised side effects that are highly treatable and can be managed by a trained clinical care team.

  8. Is it effective?

  9. CAR T-cell Therapy has shown promising outcomes for the treatment of lymphoma and other blood cancers.

    The overall success rate in achieving remission with CAR T-cell Therapy is 60–80% for lymphomas, and 80–90% for leukemias. Many patients with previously relapsed blood tumours have also shown promising results with no evidence of cancer after receiving treatment.

    CAR T-cell Therapy offers patients with blood cancers a potential life-saving treatment option in the event that their disease is not controlled by standard chemotherapy, targeted therapy or bone marrow transplantation.

    However, as it is a relatively new area of cell therapy, there are some challenges to consider such as the selection of patients who will benefit from this treatment, their level of medical fitness, the timing of cell collection, logistical concerns, and the risk–benefit ratio of treatment for the individual patient. Nevertheless, CAR T-cell Therapy remains a revolutionary therapy with high success rates, and may be an option for non-haematological cancer treatments in the near future.

POSTED IN Cancer Treatments
TAGS blood cancer, blood disorders, blood transfusion, immunotherapy
READ MORE ABOUT Acute Lymphoblastic Leukaemia (ALL) in Children, Hodgkin Lymphoma, Non-Hodgkin Lymphoma
PUBLISHED 01 APRIL 2022