I'm not going to spend too much time on Cancer Survivor's Day today (if you want to look back at what I had to say in the past, feel free -- it still holds true, especially the part about having a crush n figure skater Katarina Witt when I was a teenager).
More importantly, there are ASCO abstracts still waiting out there to be discussed.
My friend William asked me to check out what's being said about CAR-T. (William and Ben write a blog on CAR-T and Follicular Lymphoma. Ben had CAR-T, as did William's wife.)
There is a LOT of stuff on CAR-T at ASCO. It's an exciting treatment that shows a lot of promise. I've written about it before (a lot), but here's a reminder of how it works:
One of the body's defenses against invaders is a kind of white blood call called T cells. There are actually a bunch of different kinds of T cells, but there basic job is to figure out that there is an invader (like a bacteria or a virus) and attack it. T cells can multiply rapidly, so millions of them go on the attack.
But T cells don't work on cancer cells. Cancer isn't an invader from outside -- it's our own cells that have gone wrong. So CAR-T is a way of using T cells to go after cancer cells. Some T cells are removed from the body and changed in a way that lets them treat cancer cells as outside invaders. The new T cells can multiply and overwhelm the cancer just like they would any invader.
CAR-T is still in developmental stages (though it has been approved for aggressive transformed Follicular Lymphoma). Right now, about one third of patients have a long response to CAR-T, about one third have a response that lasts less than a year, and about one third do not have a response. My own oncologist thinks it will be much more effective in about 5 years. Another problem is that it is expensive -- it is basically a personalized cancer treatment, made just for each specific patient. It can also have some serious side effects, as the body is overwhelmed by the army of T cells, causing a reaction that could be fatal if not treated.
With so many presentations on CAR-T at ASCO, I won't get into too much detail about them, but here are some of the highlights:
- One studied looked at Quality of Life in CAR-T versus Stem Cell Transplants. Unfortunately, aggressive treatments can result in severe side effects and lower QoL. The study found that CAR-T patients had the same QofL as the STC patients, and may have had fewer physical side effects in the month that followed treatment/
- Another looked at Cytokine release syndrome, also known as CRS. That's the potentially deadly reaction that the body has when so many T cells kill off other cells at one time. the body has a reaction that's almost like getting a really bad flu. One presentation offered a way to detect CRS and deal with it before it becomes too harmful. (This has been a big area of research for the last few years, and it seems like doctors are able to watch for CRS and deal with it early.)
- Another used PET scans as away to predict how effective a CAR-T treatment would be. By looking at a PET 30 days after CAR-T treatment, and comparing it to PETs taken after 90 days, researchers could figure out how to tell if the 30 day PETs could predict whether or not the CAR-T would be successful. early predictors like this are important; rather than waiting another 2 months to see if it worked, some patients can start a new treatment much sooner, saving valuable time.
- Another looked at outcomes for DLBCL patients who had CAR-T. they found that patients who relapsed within 3 months of treatment had poor outcomes. But those who relapsed 3 months or longer after getting CAR-T did much better with the treatment that followed.
I'm looking forward to seeing how CAR-T improves over the next few years. There is certainly a lot of research that's looking into making it happen.
Thanks Bob.
ReplyDeleteFollowing a March 2, 2016 NIH CAR-T infusion, my wife (FL) remains in CR.
William
Hi Bob , CAR T sounds so promising! if lines of chemo failed at least there is this potential lifesaver just read in the forum of lymphoma.com that a 2nd generation CAR T is underway,
ReplyDeletehttps://lymphomanewstoday.com/2018/1...tential-study/
https://www.sciencedaily.com/release...utm_source=TMD
Jeanne