Understanding CAR T-Cell Therapy
- Sam Neill, who was diagnosed with an aggressive form of non-Hodgkin lymphoma called angioimmunoblastic T-cell lymphoma (AITL) after noticing a persistent lump in his neck years ago, is now “cancer-free” thanks to CAR T-Cell therapy.
- CAR T-Cell therapy involves removing a patient’s T cells, genetically modifying them to fight cancer, and then injecting them back in
After the T cells have been extracted and genetically modified, a patient will usually receive about three days of chemotherapy - The therapy is being tested for use in various types of non-Hodkin’s lymphoma, as well as in Hodgkin lymphoma and in chronic lymphocytic leukemia (CLL).
- Neill underwent a clinical trial to undergo CAR T-Cell therapy.
The 78-year-old movie legend announced this week he’s finally cancer free “thanks to science,” offering insight to 7News Australia in a recent interview.
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Neill also took to social media to share the uplifting news, further “advocating for new cancer therapies.”
He captioned an Instagram post, featuring his 7News interview, “Thanks to science I am cancer free. I don’t really like talking about me and cancer. Makes me uncomfortable. But here is the background to the above and the journey of how I arrived here.
“I had been on chemotherapy for some years, but the chemo for my particular lymphoma was starting to not work anymore. Things were getting a little … serious. We were all at a bit of a loss. Then out of the blue I found myself on a clinical trial.”
Timeline: What To Expect During CAR T-Cell Therapy
Neill continued, “This for a new type of CAR-T therapy, that was aimed at my particular lymphoma. All brand new. We were sailing into uncharted waters. No one knew exactly what we could expect. I think I was first out of the block and I think the term for me was ‘Patient Zero.’
“From now on please address me as Mr Zero! This turned out to be great good fortune for me. And last week I had all the scans etc, and I am pleased, indeed delighted to say that there is no cancer in my body. All clear. We are all amazed.”
Expert Resources On CAR T-Cell Therapy
- CAR T-Cell Therapy Side Effects Can Be Serious, But Many Are Short-Lived
- CAR T-Cell Therapy for Non-Hodgkin Lymphoma
- CAR T-Cell Therapy, Bispecific Antibodies — Choosing Between Innovative Treatment Options
- CAR T-Cell Therapy: A Step-By-Step Guide to Having This Breakthrough Treatment
- Bispecific Antibodies vs. CAR T-Cell Therapy: What Are the Differences Non-Hodgkin Lymphoma Patients Need to Know?
- Can You Afford the High Cost of CAR T-Cell Therapy?
- CAR T-Cell Therapy’s Current and Future Success
- CAR T-Cell Therapy: How it Works, and Who Can Get It
- CAR T-Cell Therapy: Making Your Body a More Efficient Cancer Fighter
- CAR T-Cell Therapy: Managing Side Effects
- CAR T-Cell Therapy: Understanding Cytokine Release Syndrome (CRS) and Neurotoxicity
After admitting he’s still “processing this miraculous information,” he concluded, “But of course it is not a miracle, it is science at its best. And a lot of people who care deeply about their work and their patients. I am immensely grateful.
“Now. Here’s why I’m posting this. Treatments like this — CAR-T therapies and others coming through in a rapidly changing medical world — I hope to be available to everyone who needs them in Australia & NZ (and worldwide ). This is what I am advocating.”
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Loved ones and fans flooded his Instagram with support, with one comment reading, “Oh wow this could be a game changer for cancer care all over the world. Delighted to hear of your recovery and unsurprised to hear of your courage in advocating for others.”
Another wrote, “Thank you Sam for sharing such personal information. Science is ever evolving and hoping it can knock cancer on the head one day.”
“Sam Neill, his victory against cancer is the greatest proof of his inner strength,” commented a third. “May this new chapter of your life be blessed with full health and may your trajectory continue to inspire everyone around you. You are a giant!”
CAR T-Cell Therapy for Non-Hodgkin Lymphoma
Sam Neill’s Cancer Journey
Neill’s cancer journey began in March 2022 when he felt lumps in his neck. His doctor initially told him it was because of a COVID-19 infection, but as his symptoms persisted, prompting him to push for more solid answers.
“I said, these lumps don’t seem to be going down, and I don’t know why,” Neill explained in his memoir “Did I Ever Tell You This.”
Neill was in the middle of promoting “Jurassic World: Dominion” when his neck swelled. People magazine reported that the actor didn’t give his neck much thought until photos from the event showed that it appeared “lumpy.”
Neill talked with his doctor, who attributed the symptoms to another condition.
“He assured me that my lumpy glands were due to undetected COVID, and they’d be hanging around for a little while. I went back a week later when they were even bigger. This time, he sent me to the hospital for some tests,” Neill told People Magazine.
An eventual PET scan led to his angioimmunoblastic T-cell lymphoma (AITL) diagnosis, which is a rare and aggressive form of non-Hodgkin lymphoma.
What Is Angioimmunoblastic T-cell Lymphoma?
According to the National Organization for Rare Diseases, Angioimmunoblastic T-cell lymphoma (AITL) is a rare form of non-Hodgkin lymphoma.
Non-Hodgkin lymphoma is a “group of related malignancies (cancers) that affect the lymphatic system (lymphomas)” and lymphomas “are cancer of white blood cells (lymphocytes) and can be divided depending on the type of cells, B-lymphocytes (B-cells) or T-lymphocytes (T-cells).”
Angioimmunoblastic T-cell Lymphoma is classified as a Peripheral T-cell lymphoma and makes up 4% of all lymphomas.
“It is more common in older adults. It tends to involve the lymph nodes and bone marrow as well as the spleen or liver, which can become enlarged,” the American Cancer Society explains. “People with this lymphoma usually have fever, weight loss, and skin rashes and often develop infections.”
This type of lymphoma also has a quick progression. And although treatment is usually effective at the start, the lymphoma often is recurrent.
All About CAR T-Cell Therapy For Non-Hodgkin Lymphoma
For patients who have not responded to treatments for the most common type of non-Hodgkin lymphoma, diffuse large B-cell lymphoma, a remarkable treatment option called CAR T-cell therapy is now available. The U.S. Food and Drug Administration approved the therapy in May 2018.
The promising treatment, which is essentially a “living drug” — or one made from fully functional cells — involves removing a patient’s T cells from their body, genetically modifying them to fight cancer, and then injecting them back in.
“The problem with cancer in general is that the patient’s own T cells — the cells that help fight cancer — unfortunately don’t recognize their own cancer anymore,” Dr. Julie Vose, chair of the department of oncology and hematology at the University of Nebraska Medical Center’s Buffett Cancer Center, previously told SurvivorNet.
CAR T-cell therapy “helps to wake up those cells to be able to fight their own cancer, whereas their own, unmodified cells cannot do that,” Dr. Vose says.
How Does CAR T-Cell Therapy Work?
During CAR T-cell therapy, a patient’s T cells are extracted from the body, then sent out to a pharmaceutical company and modified genetically with something called a vector. The vector helps the cancerous tumor cells to attach to the T cells, which Dr. Vose describes as having been “woken up to help recognize the cancer cells a little bit more and then to fight it.”
After the T cells have been extracted and genetically modified, a patient undergoing CAR T-cell therapy will usually receive about three days of chemotherapy. The chemo is given not to attack the cancer cells, but to get rid of the damaged immune system to make way for the new T cells to come in and do their job.
After that immune system has been wiped clean with the chemo, the patient then receives an infusion of their own genetically modified T cells.
Dr. Vose points out that after the treatment, patients face the possibility of experiencing serious side effects. For this reason, many patients undergoing CAR T-cell therapy will need to be closely monitored for a number of weeks or months.
Can Patients with Other Types of Lymphoma Benefit from CAR T-Cell Therapy?
CAR T-Cell therapy is being tested in clinical trials for use in other types of non-Hodkin’s lymphoma, as well as in Hodgkin lymphoma and in chronic lymphocytic leukemia (CLL). Some of these trials are in very early stages, meaning it could be a number of years before CAR T-cell therapy, if proven effective, will be available for these other cancers.
So far, Dr. Vose says the clinical trials show promise.
Where to Begin – If You’re Interested In CAR T-Cell Therapy
The first step is the discussion with your hematologist/oncologist about whether CAR T-cell therapy is a possible next move. In the Atlanta area, many major centers such as City of Hope Cancer Center offer CAR T-cell therapy.
You’ll want to ask:
- Have you had the required prior treatments (typically at least one or two lines of chemo-immunotherapy) and did the lymphoma relapse or become refractory?
- Is your overall health (heart, lungs, kidney, liver function) good enough to tolerate this treatment?
- Is the designated cancer center certified and experienced in CAR T-Cell Therapy?
- What are the logistics and support services (accommodation, monitoring, caregiver responsibilities) for the time you’ll spend in the hospital/local area?
- If you have relapsed non-Hodgkin lymphoma, your doctor should discuss CAR T-cell.
“We start talking about CAR T-Cell Therapy immediately. The sooner we can start working with a patient with relapse the better because there is a preparation period, because I would say it may take a week or two for insurance approval,” Dr Leslie Popplewell, Medical Director of Hematology and Blood and Marrow Transplant at City of Hope Cancer Center Atlanta, previously told SurvivorNet.
Understanding Treatment Options
In general, lymphoma treatment largely depends on the nature of your specific diagnosis. For non-Hodgkin lymphoma patients, their cancer is more likely to spread in a random way and be discovered in different groups of lymph nodes in the body. Hodgkin lymphoma cancers, on the other hand, are more likely to grow in a consistent way from one group of lymph nodes directly to another.
And even if you receive a lymphoma diagnosis at a later stage, Dr. Elise Chong, medical oncologist at Penn Medicine, assured SurvivorNet that “unlike other cancers, where advanced stage is a death sentence, that’s certainly not the case for lymphoma.”
“We have many treatments with which people can either be cured with advanced stage lymphoma or have very good remissions,” Dr. Chong said. “So it doesn’t change how treatable someone is, even when they do have advanced stage lymphoma.”
WATCH: Learning about Non-Hodgkin Lymphoma
What Life May Look Like After Treatment
If patients have not experienced too many complications from their chemotherapy, “they are often able to go back to many of the same things that they did before they had their diagnosis of cancer and are able to live full and complete lives,” Dr. Michael Jain, medical oncologist at Moffitt Cancer Center, told SurvivorNet in an earlier interview
Making a Survivorship Care Plan
So what comes after successful treatment? “At that point we often focus on the survivorship issues that they may have, preventing second cancers, and properly following them,” Dr. Jain explains.
A survivorship plan will include a schedule for follow-up exams and tests, plus a schedule for tests to check for any long-term health impacts from your cancer or treatment, and screening for any new cancers.
Your doctor will likely tell you what to look out for in terms of side effects that could show up late or over the long term. Your care team will provide you with diet and physical activity recommendations as part of your survivorship plan.
Moving On From Treatment
It’s natural to feel continuing mental health effects, such as depression and anxiety, even after your treatment ends. This is where you can benefit from a supportive community. Look to strengthen your relationships with friends and family, faith groups, support groups, and mental health professionals to buoy you as you move on from treatment.
In addition to caring for their mental health, people who finish treatment and are in complete remission will want to move on from cancer with a physically healthy lifestyle. Eating nutritious foods, exercising regularly, staying at a healthy weight, and not smoking are all lifestyle practices that generally contribute to a healthy quality of life.
Indeed, cancer and its treatment might naturally point survivors in the direction of such practices. “Mostly [we’re] trying to maximize the quality of life that people have, because once you have a cancer diagnosis, I think it is an important time in someone’s life where they can take stock and really understand what’s important,” Dr. Jain adds.
There’s Life After Cancer
Sometimes it can be hard for cancer patients to see the light at the end of the tunnel especially after being hit with a diagnosis. However, SurvivorNet has shared thousands of stories from cancer warriors that prove everyday challenges tend to improve over time. With the support of loved ones that make up your support group, you too can find a way to navigate your emotions.
Your support group also helps motivate you while undergoing the rigors of cancer treatment. While every cancer warrior’s journey is unique, one thing is certain, you are more than your diagnosis.
Neill and many other cancer survivors continue to demonstrate there’s life after cancer every day by focusing on what brings them joy, happiness, and gratitude.
WATCH: Living In Gratitude
Gratitude means being thankful for what you have and showing appreciation for it. It’s a mindset that helps people going through tough times, and the experts SurvivorNet spoke with encourage cancer warriors and their loved ones to practice gratitude.
Dr. Zuri Murrell, a colorectal cancer surgeon at Cedars-Sinai Medical Center, told SurvivorNet that his patients who live with gratitude tend to handle treatment better because this attitude is one way to stay mentally healthy.
Contributing: SurvivorNet Staff
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