Saturday, December 12, 2015

ASH: Early CAR-T results for Follicular Lymphoma

Before I get to the cancer stuff, a couple of personal items:

First, I had my annual physical exam a couple of weeks ago. This wasn't an oncologist appointment, just my regular doctor, and she was pleased overall, especially with the 20 or so pounds I have lost since the summer. Everything looked good. I got my blood test results yesterday, and everything looks fine there (other than a little blood cancer, of course). My cholesterol is still low, and my vitamin D is high. My B12 is "on the lower end of normal," so I'm going to start a supplement. But otherwise, I think I have retaned my title as the healthiest cancer patient in town.

Second, today is my dog's birthday. She's nine years old.

She's a standard schnauzer, but unlike George, she's useless when it comes to sniffing cancer. But we love her anyway.


Now, on to the Follicular Lymphoma stuff.

The pharmaceutical company Novartis announced at the ASH conference that they are seeing good results with their treatment CTL019, a Chimeric Antigen Receptor T cell therapy, or CAR-T therapy.

CAR-T therapies are one of those treatments that are getting lots of cancer people excited these days. They seem to be working on lots of different types of cancer, liquid and solid, but seem especially suited to blood cancers like Follicular Lymphoma.

CAR-T is really cool. It's a type of immunotherapy, so it uses the body's own immune system to fight the cancer. Usually, cancer works because the body can't recognize that it doesn't belong there, so the usual immune system defenses (like T cells) just look the other way when they encounter a cancer cell.

CAR-T therapy makes sure that doesn't happen. T cells are removed from the body and given a reprogramming so they recognize the cancer cell as something to be destroyed. In the case of CTL019, the T cells recognize CD19, a protein on the surface of the cancerous cells (kind of like Rituxan recognizes CD20).  Once it recognizes the CD19 and hooks on to the cancer cell, it beats the crap out of it. says the CAR-T cells act like the antibodies that are naturally present in our blood, and expand to become a "living drug." They are effective as long as they stay in the blood and keep doing their job (which might be the tricky part). You can read more about CAR-T therapies for lymphomas at

The Novartis folks are working on a phase II clinical trial involving 15 patients with DLBCL and 11 with Follicular Lymphoma. All of the patients have advanced disease and "have not responded to standard treatment."

The Overall Response Rate for CTL019 was 47% for DLBCL patients, and 73% for the Follicular Lymphoma patients, which is pretty good. Apparently, they plan to apply for FDA approval in 2017; I assume they will applying for accelerated approval, since they are only on a phase II trial at the moment and it seems a little early in that trial, and even that might only be for DLBCL. The FDA gave CTY019 a "break through" designation for ALL last year.

One problem with all of this -- we're talking about a personalized treatment, so each batch will need to be made specially for each individual patient. Only your own T cells can fight your cancer. So it will be expensive, at least at first -- about $450,000 per treatment. (Yikes.) That price will come down eventually, but it's hard to say when, and how much.

But it's a really promising concept. We'll keep an eye out for future news about it.


Anonymous said...

Hi Bob,

Thanks for covering this topic. This is the second time I am commenting on one of your posts. The first time was when you mentioned Revlimid/Rituxan, the so-called "R-Squared", as I was being treated with it.

And now you've done it again. I can provide more insight to you and anyone else reading this, as I myself am a CAR-T patient. I was infused with my "re-engineered" T cells in July, and was discharged in August after some unfortunately rather severe CRS (I needed to be in ICU for 5 days).

However, my follicular lymphoma is now in a Partial Remission (PR), with minimal activity showing in my most recent PET/CT. This is after getting minimal response from the aforementioned R-squared, and a subsequent HYPER-CVAD regimen, before entering the CAR-T trial.

We've since recommended CAR-T to another fNHL patient we learned about through a family member. He was diagnosed only a year ago, but got only a minimal response from R-CHOP and R-Bendamustine, and his lymphoma got progressively more active. He may have even started transforming.

This fellow was also infused over the summer, and now has a Complete Remission (CR), and did not have any of the CRS symptoms that I experienced. He was even able to do this as an out-patient at his facility, since his fever remained low and only lasted a couple of days.

So for anyone reading this, please know that another option exists for follicular lymphoma patients who are no longer getting good responses from their current therapies, which is of course often the nature of this disease.

I had mentioned in my first R-Squared post almost a year ago that I was considering starting a blog as you have done, and you had encouraged me to do so. I unfortunately never got around to it, but now I am re-considering. Hopefully this time I'll get around to it. I'll keep you posted...

Thanks so much for your continued coverage of current events re fNHL!


-- Ben

Tom68 said...

Hi Ben and Bob

This is really really encouraging stuff both of you sharing here.
Very best regards from Switzerland