CAR T-cell therapy, your questions answered, with Consultant Haematologist, Dr Jaimal Kothari

Here, he answers your questions about CAR T-cell therapy, a groundbreaking treatment used to treat certain blood cancers, which has most recently become available at HCA Healthcare UK at UCH for the treatment of patients with multiple myeloma.

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

CAR T-cell therapy is an advanced form of immunotherapy, also referred to as adoptive cellular therapy. It’s pioneering because instead of using drugs like traditional immunotherapy or chemotherapy, it harnesses the power of your own immune system, by genetically modifying your T-cells to target and destroy cancer. There are no drugs involved. For some people, CAR T-cell therapy offers the potential of long-term remission or even a cure.

Recently, CAR T-cell therapy has become available for the treatment of multiple myeloma, offering patients an additional treatment option and the possibility of prolonged remissions. It’s a very exciting time for us as clinicians, as we can offer the treatment to more and more people.

How does CAR T-cell therapy work?

It’s a personalised, highly targeted therapy, that begins with your T-cells, an integral part of your natural immune system. To deliver this pioneering therapy, we take your T-cells and genetically modify them in a lab to include a chimeric antigen receptor or ‘CAR’, which can identify a specific protein on the surface of the cancer cells and destroy them.

We then expand  these modified cells so that there are millions of them. Then, we re-infuse them back into your body, where they use their chimeric antigen receptor (CAR) to find, latch onto, and directly attack and destroy the cancer cells. 

How is CAR T-cell therapy different from other cancer treatments?

Unlike traditional treatments such as chemotherapy or radiotherapy, which can damage healthy cells as well as cancer cells, CAR T-cell therapy is designed to work only on cancer cells, leaving healthy cells unaffected. This precision reduces many of the side effects associated with other cancer treatments.

Does CAR T-cell therapy only work for blood cancers?

Right now, CAR T-cell therapy is only a treatment option for certain blood cancers that haven't responded to other standard treatments.

As with any treatment, CAR T-cell therapy isn’t universal. So, while we’ve seen excellent results in treating certain blood cancers, its not currently used to treat solid tumours outside of clinical trials. But this research is ongoing and showing promise, so I’d say we’re optimistic about its potential in the future, and there are likely to be a larger number of CAR T-cell therapies available for patients with different types and stages of cancer.

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

Currently, CAR T-cell therapy is generally introduced as a second-line, or later treatment option. Standard treatments, like chemotherapy or targeted drugs, are still the most effective treatment option for many people, particularly as a first step.

Clinical trials are exploring the potential of CAR T-cell therapy as a first-line treatment for high-risk patients with certain aggressive blood cancers, and there have been some promising results. In some cases, based on research outcomes, clinicians are already using CAR T-cell therapy to treat myeloma patients earlier in their disease course. Over time, it may become a standard option for more people, but this requires further evaluation.

What types of blood cancer can CAR T-cell therapy treat?

Currently, CAR T-cell therapy is used to treat certain blood cancers, including acute lymphoblastic leukaemia, transformed follicular lymphoma, primary mediastinal large b-cell lymphoma, diffuse large B-cell lymphoma, mantle cell lymphoma and, most recently, multiple myeloma.

How many times do you need to have CAR T-cell therapy?

One of the key benefits of CAR T-cell therapy is that, unlike other therapies, it has the potential to be a one-time, singular treatment that provides benefits throughout a patient’s entire lifetime. This is because it gives the body immunological memory. What this means is that the person’s immune system can remember a certain stimulus, like a cancer cell, so it can destroy it when encountered again.

How do you decide which people may benefit from CAR T-cell therapy?

We review each case carefully to ensure CAR T-cell therapy is the right option. Our team of haematologists and specialists work together to provide a personalised treatment plan for each individual.

If you have been diagnosed with blood cancer, your consultant will be able to talk you through your treatment options, including if CAR T-cell therapy could be effective for you. 

Interested in CAR T-cell therapy?

If you’d like to learn more about CAR T-cell therapy and whether it’s the right option for you, our team at HCA Healthcare UK is here to help. Learn more about CAR T-cell therapy and how to contact us here