City of Hope Hematologist/Oncologist, Dr. Tanya Saddiqi, MD talks about how CAR T cells saved one man from Non-Hodgkin lymphoma.
Interview conducted by Ivanhoe Broadcast News in July 2022.
What is CAR T-cell Therapy?
SADDIQI: CAR T-cell Therapy is a way to take patient’s own immune cells, the healthy immune cells, called T-cells, and to change them in the lab in a way that instead of looking for infections to fight infections, the CAR T-cells then are trained to look for the lymphoma, and fight the lymphoma. Instead. We take these T-cells out of the patient’s body, we give the patient treatment. In the meantime, it takes about two to four weeks for the CAR T-cells to be manufactured. And then right after some chemo, we give patients back their CAR T-cells. Within a month, we see that often times patients are in a complete remission. And the goal then is to make sure that remission lasts, and in his case, it’s lasting more than five years now. So he’s a very lucky guy.
Has Chuck come back to do anything?
SADDIQI: He comes from labs. He comes for scans. If he has an infection, we treat his infection but no lymphoma, no chemo, no other treatment. That was it, the one time CAR T-cell.
Which seems amazing to me, because why didn’t they just do that at the beginning? It seems so much easier than all the other things.
SADDIQI: The process of any treatment being FDA approved for front line versus relapse, versus after two lines of therapy, etc, has to go through clinical trials. The way the CAR T-cells were FDA approved, worth through the CAR T trial that Chuck was on. The first time we got this axis cell to be FDA approved was because the trial that Chuck was on, proved to be such a success compared to everything else that particular patient would have offered to them in that moment in time. So the way that FDA approved it was having failed to prior lines of therapy. Meaning, you had to have chemo, some patients had to have transplant, and then you can come to T-cells. So, that’s just the way that the process goes. Now we’re trying to see can we do it earlier? Can we do it after just one try of chemo, and don’t even bother with transplant? But that’s where we are now. Back then, it was just being tried, and so we had to wait until they’re tried some other standard treatments first.
How did these CAR T cells attack the cancer?
SADDIQI: The T-cells are the patient’s own T-cells and then they’re modified to recognize, and attack, not infections anymore, which is what T-cells normally do, but rather the B-cell lymphoma, There’s a target that they go look for called CD19 in the case of these particular T-cells. And the CD19 is present on the cancer cells as well as normal, healthy lymphocytes, B-cells, but mostly the cancer cells. So when we give the patients back their CAR T-cells, they’re going away like Pac-man, trying to eat up the cancer cells primarily.
Are there patients that this works better on than other patients?
SADDIQI: It’s been FDA approved for aggressive lymphoma first, and also something called mantle cell lymphoma first. We are now studying it in less aggressive lymphomas like CLL. So we do a lot of clinical trials on that, and other diseases too. But it worked beautifully in lymphomas. Let’s put it that way. There are a lot of trials going on nowadays to try to see whether we can do CAR T-cells for other cancers, not lymphoma, but other cancers, and to be honest, lymphoma is the best example of where it works the best for some reason.
Do you think that this will be a first line in defense ever?
SADDIQI: That’s a little hard to predict. I think what we’re trying to do in current trials is to see whether we can do it close to the front line, or close to the first line in patients who have some aggressive genetics in there already aggressive lymphoma, so the even more aggressive behaving aggressive lymphomas. Secondly, if you start with a couple of cycles of standard chemo, and you don’t see a great response, instead of switching chemo, and going to something else, go straight to CAR T-cells. And that’s the trial we’re doing now, and we’re gaining insight and information.
Are these CAR T-cells even more powerful on lymphomas than stem cells?
SADDIQI: Historically, stem cell transplant, the kind that truck God, meaning using his own stem cells, or autologous stem cell transplant, it’s called. It can work to cure patients about anywhere 15-40 percent of the time. These CAR T-cells have shown to produce cures about 40-45 percent of the time. So we think they’re better. But there may be certain instances where we might still say, “Hey, just do a transplant. And I’ll tell you the difference if I may. If somebody is in a complete remission from their chemo, meaning they got chemo. They relapsed. They got chemo again, they went into remission. You can’t do CAR T-cells in that situation, because you need cancer for the CAR T-cells to go eat up. It’s already in a complete remission, then transplant is the better way to keep them in remission. Whereas if they still have cancer in their bodies, then CAR T-cells is the better way to go.
Have you done this on a lot of patients? Would you say Chuck is in remission or cured?
SADDIQI: Yeah. I would say cured. If you go beyond five years in his type of disease, we call it cured.
Are you seeing all the patients being cured?
SADDIQI: No. So, 40-45 percent is the real cut off. That means there’s still a lot of room for improvement. But these, if I can put it bluntly, 40-45 percent patients would have surely been dead, in that first year. Now, there are five years or more alive and cured potentially. So, it’s a big chunk of patients, but there’s still a big chunk where we’re not doing as well.
END OF INTERVIEW
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