car t-cell therapy is here and it's reshaping the future of precision cancer treatment
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patients have to meet eligibility criteria for car t-cell therapy, which usually includes receiving chemotherapy and an autologous stem cell transplant. if these have failed, then car t can be considered.
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this article was produced by the healthing editorial team with the support of a grant from bristol myers squibb canada. while bristol myers squibb canada made the production of this article possible, they did not have any editorial influence or control over the content, including review prior to publication.
in december, gurjot basra had the chance to go to california to see a facility that manufactures car t cells, the game-changing innovation to treat certain blood cancers and save lives. this is where the science happens—a patient’s own t cells, a type of white blood cell in the immune system, are genetically reprogrammed to fight cancer cells.
“it was absolutely fantastic. i know the procedure can seem complex, but when you’re there, you truly understand all of the infrastructure that’s involved, all of the quality control measures that they have to take in order to ensure quality of the cells. it was really amazing,” says basra who is a dedicated advocate for helping canadians access treatment. as manager of patient programs, research and advocacy at lymphoma canada, she talks a lot to patients and their families about what happens after a diagnosis. the journey isn’t an easy one. if you know someone with cancer (odds are that you do), you’ll likely agree.
she also got to speak with canadian patients on the facility tour who had gone through car t-cell therapy, giving them hope after their blood cancer returned following chemotherapy and stem cell transplant. car t-cell therapy was a lifeline for them, basra explains. “the tour was a very emotional experience for them. there was a lot of tear shedding, not just on their end but on our end. just hearing their stories and they got to see how car t is prepared. they were so grateful.”
science fiction? no, car t-cell therapy is happening right now
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while awareness of car t-cell therapy has grown since its introduction to blood cancer treatment in 2018, there’s still a perception that the approach is more far-off science fiction than happening in cancer clinics around the world. the reality is, the therapy has become sought-after standard of care for certain cancers after patients have undergone other options like chemotherapy and autologous stem cell transplants (with cells harvested from the patient’s own body).
patients with leukemia were among the first to receive car t-cell therapy, and adults, like those she met on the tour, with relapsed or refractory diffuse large b-cell lymphoma (dlbcl), a type of non-hodgkin lymphoma, were other early candidates, basra says. dlbcl is the most common form of lymphoma, making up 30 to 40 per cent of patients with non-hodgkin lymphoma. it’s an aggressive lymphoma that requires urgent treatment. she points out that there are more than 80 different subtypes of lymphoma, and research is underway for car t-cell therapy for other types of lymphoma and other cancers like breast, lung and brain cancer.
“in the oncology space, treatments are always on the rise. it’s a very fast-paced challenging environment and it can get hard to keep up with all the therapies that are coming up,” she says.
harsh side effects of chemotherapy difficult for patients
most people who come to lymphoma canada are familiar with chemotherapy but want to know what else is available, given the difficult nausea, vomiting and fatigue that occurs. “they are getting tired of the intense side effect profiles that come with chemotherapy. and if they’re not familiar with car t, their question usually is ‘we’ve been researching this for years. what else is there available to me?’”
basra explains that chemotherapy and the more traditional forms of therapy focus on killing all of the cancer cells. the problem is, in the process, you’re also killing the healthy cells as well. “it’s mass destruction, that’s the best way to describe it,” she says.
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what is so great about car t, which stands for chimeric antigen receptor engineered proteins, is that it focuses on personalized medicine. it’s a targeted approach where the unique t cells from a patient are turned into powerful proteins that recognize and destroy cancer cells. “we’re making strides in the right direction, generally shifting away from the traditional methods of chemotherapy onto more targeted approaches.”
patients have to meet eligibility criteria for car t-cell therapy, which usually includes receiving chemotherapy and an autologous stem cell transplant. if these have failed, then car t can be considered. basra points out that not all patients qualify for car t because they have to have a certain fitness status and measured capacity to be able to take on the toxicities that come with car t. “beyond that, if they are eligible then the thing is in canada, car t is not a simple procedure. it involves a lot of infrastructure and even human resources.”
the process starts with the extraction of a patient’s t cells which are sent off to a manufacturing facility for genetic engineering. in a one-time procedure, the car t cells are re-infused into the patient so they will be able to bind directly to the cancer cells and go ahead with the destruction process.
“the final product is a small bag of frozen cells. essentially that’s transported back to the hospital for the infusion process. the infusion takes a few hours.”
car t-cell therapy extending lives of lymphoma patients
it’s early days to fully understand the success of the treatment, but remission ranges from two to five years with about 40 per cent of dlbcl patients living well to the two-year mark. surveys by lymphoma canada have revealed that patients who’ve received car t-cell therapy find that the side effects are a lot more manageable with milder fever, some nausea, constipation and possible headaches.
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also, with the real-world data that’s been collected, about 83 per cent of patients will experience crs, which is cytokine release syndrome, an inflammation response when your immune system has been over-activated. basra says most patients experience a mild form of crs with fever and perhaps low blood pressure. “and only eight per cent of individuals will have a more severe case. so i still think that the side effect profile is headed in the right direction.”
without car t-cell therapy, however, patient options will be either in palliative care or enlisting in clinical trials for some other targeted therapies. many can’t proceed with a stem cell transplant because they still have a high disease burden of their cancer. basra says she’s excited by another car t advancement as an option for second line therapy with breyanzi recently approved by health canada for patients with relapsed or refractory dlbcl.
she’s also watching the progress in the u.s. of car t-cell therapy for treating chronic lymphocytic leukemia (cll), a slow-growing lymphoma where treatment is not recommended right away. “so patients have to go through the process of watching and waiting, and that can be very excruciating not knowing when you’re going to need treatment. not knowing when symptoms are going to flare up. so if we could get car t available for cll as a curative means that would be fantastic.”
the push to break down barriers to treatment
part of her role is to advocate for access to treatment and break down barriers like the time lag from approval to provincial availability to patients. for car t-cell therapy, she is only too familiar with the requirement for skilled experts to run the procedure and the fact that there are only a few centres in canada in place with limited capacity for patients.
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the patients she met on the tour of the facility in december are from the atlantic provinces, but they had to go to ottawa to receive treatment. “for one young man who had cancer, he was actually flown out to ottawa. if you’re receiving car t therapy, you have to be close to the cancer centre for a few weeks, if not months.”
his wife had to pack up their life in the maritimes and drive with their dogs across the country to ottawa so that they could situate themselves there.
“not everybody is able to do that. not everybody has a caregiver at their expense to help them through the process. so there’s lots of factors that need to be considered in that regard,” basra says. her team is updating a white paper to evaluate the progress that has been made for timely access to innovative therapies like car t cell for canadians and delays that need to be resolved.
“we’re shifting away from chemotherapy. we’re moving toward a space of targeted therapies in which we’re empowering your own immune system to fight cancer. more options are becoming available. in that regard, i would say that we’re moving into a time of hope.”
february 4, 2025 is world cancer day. to learn more, visit the world cancer day website.
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