Sunday, February 12, 2017

CAR-T

A couple of items related to CAR-T that are a little bit older, but worth looking at:

First, the online magazine CureToday has an article on CAR-T, specifically the ZUMA-1 trial that was reported on at the ASH conference in December, and in the journal Blood.

The article described the results from the ZUMA-1 trial, which looked at CAR-T in patients with aggressive lymphomas, mostly Diffuse Large B Cell Lymphoma (which is why I didn't write about it earlier), but also transformed Follicular Lymphoma (which is why I'm becoming aware of it now). I'll let you read the articles yourself, but basically, the patients were given a CAR-T treatment called KTE-C19, which targets lymphoma cells that have the CD19 protein on their surface. With a CAR-T treatment, the patient's T-cells (a kind of immune cell) are removed from the body, changed so that they recognize the cells with CD19, and then put back into the patient's body, where they hunt down the bad guys.(Lymphomation.org updated their section on CAR-T about a week ago; you can find some nice links there to find out more about the treatment.)

For cohort 1, the DLBCL patients, the results were excellent -- about 76% of patients (51 patients overall) had a response. Just as  importantly, the "manufacturing" process was successful, with 99% of patients being able to get their T cells changed and put back into their bodies. The average time for patients to receive their changes T cells was about 17 days, which is important because they were not all st the same site. And the CAR-T cells expanded within 14 days to the point where there were enough of them floating around to be able to do their job, the way naturally-occurring T cells do. So, lots of successes.

Cohort 2 included the transformed Follicular Lymphoma patients, and was much smaller -- 6 patients total, 3 of them with transformed FL. But the results were just as good. All 6 patients had a Complete Response, and all were still in complete remission after a median of 3 months of follow-up.

Now, 3 patients measured over 3 months is enough to give us some hope, but certainly not enough to make us think we have The Answer. This trial will continue, and I'm sure we all look forward to long-term results with a larger population.

Which brings me to another article: "Immunotherapy Cancer ‘Cure’ Headlines Distract from Fascinating Science." This was posted in the comments about a week ago by a reader named Popplepot (great name!) and it's worth revisiting. It was published about a year ago in the Science Blog published by the organization Cancer Research UK, soon after the first results from a CAR-T trial. The results were fantastic, and some of the experts commenting on it said things like "CAR-T might lead to a cure some day." Media reports heard the word "cure" and that became the focus, leaving out that the experts said "might" and "some day." The article reminds us of what makes CAR-T so fascinating (and it really is fascinating, given that it overcomes the basic problem with cancer -- why doesn't the body recognize cancer cells as invaders?).

But the Cancer Research UK article also makes us aware of some of the problems with early CAR-T trials -- they are small, and they also point to some nasty side effects (which resulted in a couple of deaths of patients).

So it's a good reminder for all of us to pay attention to some of the problems that come with new treatments. I know I'm guilty of this. I'm naturally upbeat and positive, so I ignore some of the negatives that come with reports of new treatments and clinical trial results. I'm working on it.

We're going to see more and more CAR-T results, I'm sure. Which reminds me of another reader's recent comments. William May, whose wife has had great success with CAR-T, was expecting the recent OncLive Peer Exchange video series to address CAR-T. It looks like they've moved on from Follicular Lymphoma treatments to CLL treatments, and no mention of CAR-T. I share your disappointment, William.

But that's OK. As I said, there will be plenty of stuff to read about CAR-T in the months and years to come. Looking forward to it.

(And thanks, Popplepot and William, for you comments.)

4 comments:

William May said...

My wife has aggressive follicular lymphoma (NOT transformed fNHL). Diagnosed in 2011 she progressed after R-CHOP, BR, Ibrutinib, and Idelalisib/rituximab. On March 2, 2016 (her new birthday) she received a CAR-T infusion at NIH - she is still in complete remission. The only lingering side effect is low IgG for which she received IVIG every 4 months. During a November 2016 webcast Q&A, Dr Stephen Shuster/UPENN said all of his 10 fNHL patients who received a complete remission are still in complete remission, one patient is 4+ years in complete remission. For fHNL patients there is some hope for the "C" word!

Romencar Rodrigo said...

Very happy for your wife, William!

Lymphomaniac said...

Amen to that, William!

Popplepot said...

Hope is the Anchor to which we must firmly hold, best in health to your Wife and family William from Belfast, Northern Ireland.