ASCO Part 2: CAR-T News

A little more from the ASCO Virtual Education session. 

There was, of course, a session on CAR-T treatments at ASCO part 2 -- CAR T-Cell Therapy: Strategies to Expand Access.

I'm going to assume that, if you're reading the blog, you have heard of CAR-T. But maybe a quick reminder would be helpful, just in case. CAR-T stands for Chimeric Antigen Receptor T-cell therapy. Basically, T cells are a type of immune cell that help clear out any invaders in the body (like bacteria or viruses). Cancer cells, while they don't belong, are not attacked by the immune system because they are not "invaders" from outside. They are our own cells that have gone rogue. The system for finding outsiders just ignores them. CAR-T therapies take T cells from the body, change them in a way that lets them recognize cancer cells as invaders, and then puts them back into the body to find and clear out the cancer cells. Ideally, like any immune cell, they grow in numbers to deal with the cancer cells, and then remember the cancer cells so they can go back to work on them if the cancer returns.

Lots of patients have had success with CAR-T, though not all of them, and researchers continue to work on making CAR-T more effective and safer (which is important because CAR-T has the potential to create some very serious side effects). If you want to read more about CAR-T and Follicular Lymphoma, I recommend this site.

There are two CAR-T treatments that have been approved by the FDA, and about 600 clinical trials around the world that are testing CAR-T (newer versions, different diseases, etc.). One of the big issues with CAR-T, though, is the cost. Because each treatment is created specifically for one patient, using that patient's cells, the cost is very high -- potentially close to $500,000 per treatment. 

The ASCO session on CAR-T focused on issues of access -- how to get the treatment to patients who might be helped by it. ASCO put out a nice summary of the session in the daily newsletter they published during the conference. But basically, the issues include things like cost, of course. But there are others.

For example, side effects can be a major problem, one that is potentially life-threatening. As one presenter pointed out, some smaller clinics may be able to administer the CAR-T treatment, but they don't necessarily have the facility to deal with some of the side effects. She hoped that researchers would be able to make CAR-T treatments better in the near future, in ways that reduce the severity of side effects, making them more available to those clinics that can't handle those safety issues.

Another issue, in addition to cost, is the time that goes into creating the T cells. Right now, they are removed from the patient and taken to a lab, where the cells are changed and then left to grow in large enough numbers to be effective. This can take weeks, and some patients can get worse or die during that time. Improvements to the process, to speed things up, may come in the near future, and may help accessibility.

But cost seems to be the biggest barrier. In the United States, this means creating a better system for private insurance and Medicare (the government-run healthcare system for older patients) to reimburse the cost of the treatment.

The good news is that all of the speakers at the session seemed hopeful that the problems they pointed out were solvable, and that making people aware of the problems was a good first step.

This is especially important for us as Follicular Lymphoma patients. CAR-T treatments that are currently available are approved for aggressive blood cancers, including Transformed Follicular Lymphoma. But a few weeks ago, early results from a phase 2 clinical trial of CAR-T for Relapsed and Refractory FL patients showed some good results. (These are FL patients whose last treatment stopped working, or didn't work at all. They aren't necessarily patients with Transformed or aggressive Follicular Lymphoma, a much larger group of patients.) Earlier this summer, a different CAR-T treatment also showed good results for the same group of patients.

Ideally, as CAR-T trials move along, and eventually get approved for more FL patients, the accessibility issues with CAR-T will also approve, so the people the treatment is meant for will actually be able to afford it, be treated with it, and do so safely.

CAR-T is one of those treatments that get lymphoma experts very excited. Here's hoping that all of their wishes come true in the next few years.