Thinking Ahead to Your Next Treatment
- When the first treatments for non-Hodgkin lymphoma don’t stop the cancer, a type of immune-based treatment called CAR T-cell therapy can become an option
- This treatment requires that you have healthy immune cells
- The more chemotherapy you get before CAR T-cell therapy, the less likely this treatment will be an option for you
- The time to start considering CAR T-cell therapy is after you’ve finished your first treatment without success
“There was no third-line standard of care until CAR-T,” he says. Even today, not everyone who could benefit from CAR T-cell therapy receives it. Despite having good success rates, CAR T-cell therapy is still relatively new. And not every practicing oncologist is aware “that this is a reality for their patients.”
Read MoreCAR T-Cell Therapy: How it Helps
Chimeric antigen receptor (CAR) T-cell therapy is a type of immunotherapy. If you have this treatment, your doctor will remove disease-fighting immune cells called T cells from your blood and genetically modify them in a lab to make a special protein called a receptor on their surface. Those receptors help them latch onto the surface of your cancer cells. Once the T cells are multiplied and returned to you, they’re better equipped to find and treat your lymphoma. Here’s the problem. In order for CAR T-cell therapy to work, you need to have a large enough supply of functioning T cells. If you start on another round of chemotherapy first, the drugs will kill off your healthy T-cells along with your lymphoma cells (called lymphocytes). “And the more treatments you go through, the fewer normal T-cells are left,” Dr. Schuster says.T cells can regrow after treatment. “But the malignant [cancer] cells are still there if your therapy has been unsuccessful and they grow alongside the normal cells,” he adds. “You may lose the race by waiting.”
When to Start This Treatment
The time to start considering CAR T-cell therapy is after you’ve finished your first cancer treatment without success. When discussing next steps, ask your doctor about treatments that target your cancer but preserve your T cells. Then if you do end up needing a third treatment, you’ll know that CAR T-cell therapy is still available to you, Dr. Schuster says.
Instead of trying to simply hold your cancer at bay with treatments that weaken your immune system, go to a center that has experience with third-line treatments like CAR T-cell therapy, he suggests.
It’s essential to save your T-cells, even if you plan to have a type of immunotherapy other than CAR T-cell therapy. You’ll need to preserve healthy lymphocytes for any of these treatments to work. “The more cycles of chemotherapy you’ve had, the less and less efficacious these treatments become,” Dr. Schuster tells SurvivorNet.
The Bottom Line
If you sail through R-CHOP and it leaves no trace of your cancer behind, you’re finished with treatment for now. But when the first therapy isn’t effective and you’re contemplating a second round of treatment, keep CAR T-cell therapy in the back of your mind.
If your doctor thinks you’re likely to have a good response to chemotherapy, it still may make sense for you to go that route. “If not, you should be immediately looking at other options,” Dr. Schuster says.
He says anyone who isn’t successfully treated the first time around should get evaluated at a cancer center that’s doing immunotherapy with CAR T-cell therapy and other approaches. These treatments have been very effective for people who haven’t had success with the first therapies they tried.
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