The Timing of CAR T-Cell Therapy
- CAR T-cell therapy for relapsed or refractory multiple myeloma is currently approved for use only after at least four previous lines of therapy.
- Ongoing clinical trials are assessing CAR T-cell’s effectiveness in patients who’ve undergone fewer previous therapies.
- Some studies are looking at CAR T-cells as frontline therapy.
"We've now tested CAR T-cells in our most vulnerable patients–the patients who really had no other options," says Dr. Thomas Martin, a hematologist with the University of California San Francisco Medical Center. These patients may already have had chemotherapy, radiation, antibodies and stem cell transplants. "In these patients we had to go to CAR T-cell just to extend their survival," says Dr. Martin.
Read MoreWhat Is CAR T-cell Therapy?
CAR T-cell therapy uses a patient’s blood in the fight against blood cancers like multiple myeloma. The first step in the process is removing specific immune cells called T-cells from a patient's blood so they can be sent to a laboratory and altered to become more efficient cancer killers. T-cells are immune cells that help your body fight off foreign and dangerous invaders, such as cancer. The process of removing the blood cells is called apheresis. The blood is removed through an IV or catheter, and the necessary cells are collected and shipped off to a lab where they will be genetically engineered to grow special structures called chimeric antigen receptors (CAR) on their surface. When these new CAR T-cells are returned to your body, the receptors help the cells identify and attack cancer cells anywhere in the body. Currently there are many clinical trials attempting to see if CAR T-cell therapy would be effective if used much earlier after a patient's diagnosis. Depending on what the studies find, it might make sense to actually begin a patient's treatment with CAR T rather than wait until so many other treatments have first been tried and failed.The Rationale for Earlier Use
"We're doing studies," says Dr. Martin. "We're in the midst of doing a variety of different studies where we’re more moving the CAR T-cell therapy to earlier lines of therapy. There are studies in frontline therapy, meaning patients are getting CAR T as their initial therapy."
There are also studies using CAR T-cells as consolidation to try to deepen the response after other treatments. Some of the trials are focused on patients who have high-risk disease. "They're getting CAR T-cell therapy to try to prolong their remission," explains Dr. Martin. "This is using CAR T-cells instead of autologous stem cell transplant as part of frontline therapy."
There are also clinical trials to see how CAR T-cell therapy works after a first or second or third relapse, rather than waiting until after four previous treatments. "Some of these trials are randomized to what would be standard therapy for the first or second or third line of therapy versus a CAR T-cell therapy," explains Dr. Martin.
Right now only patients who've had at least four previous lines of treatment are eligible for approved CAR T-cell treatment. But the clinical trials are ongoing. And, says Dr. Martin, by participating in clinical trials, patients have the “possibility of getting a CAR T-cell therapy that’s earlier in their treatment paradigm." Find more information on clinical trials here.
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