Understanding CAR T-cell therapy

CAR T-cell therapy is the latest breakthrough in blood cancer treatment, but what is the science behind this new therapy and how is it transforming care for patients who have exhausted other treatment options? Dr Chris McNamara, Consultant Haematologist at HCA Healthcare UK, explains more about this pioneering therapy.

What is CAR T-cell therapy and why is it considered pioneering?

CAR T-cell therapy is a recently approved therapy for the treatment of some blood cancers. It is a new type of immunotherapy, also referred to as adoptive cellular therapy.

This treatment uses a patient's own t-cells, which are genetically modified in a lab, expanded into large numbers, and then reinfused back into the patient. These new t-cells have a chimeric antigen receptor (CAR), which can identify protein on the surface of the cancer cells and destroy them.

One of the main reasons this treatment is considered pioneering is that traditional immunotherapy involves the use of drugs. However, with CAR T-cell therapy, we are genetically modifying a patient’s own t-cells, and by adding a chimeric antigen receptor, they can track down the cancer cells and destroy them, without using drugs.

We often hear of medical breakthroughs, but for us as blood cancer specialists, this truly signifies a new era of personalised medicine - which can potentially provide long term remission or even cure some patients who would previously of had no other treatment options.

Why does it only work for some blood cancers?

Not all cancers are the same. CAR T-cell therapy has been designed to target a specific protein found on the surface of some cancer cells, called CD-19. Through clinical trials we have seen promising results in the treatment of certain types of lymphoma and acute lymphoblastic leukaemia. Clinical trials are ongoing in other blood cancers, and we are hopeful that in time this therapy will be used to treat more and more patients.

As with any medicine, we are always looking at ways to improve and evolve treatment options and outcomes. We are hopeful that in the future we may even be able to apply this science to other types of cancer.

Why isn’t CAR T-cell therapy a first-line treatment option?

In many cases, standard line therapies continue to be the most effective treatment option. However, in some these therapies do not work, in these instances CAR T-cell therapy could be the best option, as it has been designed to target cancers that are chemotherapy resistant.

Although we are very optimistic about CAR T-cell therapy, it is still a relatively new treatment. We still need to collect long-term data outcomes and continue to monitor the efficacy of treatment, which is why in some cases, it is offered in a clinical trial setting. It will not be suitable for every patient, but for those who are eligible, it signifies a new treatment option that was previously unavailable, which in some cases can be lifesaving.

It may be that in time CAR T-cell therapy becomes a more widely available standard treatment option, but like any new treatment the right processes need to be applied and this takes time and longer-term review.

How can I access CAR T-cell therapy at HCA UK at University College Hospital?

We have robust governance systems in place to ensure we can review each referral on a case by case basis, as part of a multidisciplinary team meeting. This means eligibility is reviewed by a team of haematologists and other healthcare professionals, who will consider multiple factors and ensure patients who may benefit from this therapy can continue to treatment.

In some cases, private medical insurance providers, or sponsoring embassies/health offices, may cover the cost of treatment or some patients may self-fund their care.

You can find out more about CAR T-cell therapy here.