ASCO: CAR-T

First of all, a Happy Cancer Survivor's day to everyone!  The National Cancer Survivors day Foundation defines a survivor as anyone who has been diagnosed with cancer who is still alive today. It's a day worth celebrating. In fact, it's a reminder that every day is worth celebrating -- we should be sure to take some time, every now and then, to remember that.

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.

There weren't any presentations that looked at only Follicular Lymphoma and CAR-T. The clinical trial series that focuses on CAR-T and lymphoma is called ZUMA. So ZUMA-1 looked at DLBCL and Transformed FL, and the results of that trial were the reason CAR-T was approved. There are a bunch of trials (at least 8) that are looking at CAR-T and other blood cancers. One of them is looking at FL (not transformed FL, but just regular old FL). No results yet, at least not anything worth presenting at ASCO. Maybe at ASH in December, or ASCO next year.

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.