By Joshua Mansour, MD
Have you heard about the futuristic ‘CAR’ that might soon be speeding past cancer?
No, this is not a new automotive car being released this spring, but instead is something even more exciting. This type of CAR is a cancer therapy that is making headlines and is now on the road to being one of the treatments of the future.
In a throwback to Henry Ford’s Model T, this medical innovation is called CAR T-cell therapy. The CAR stands for Chimeric Antigen Receptor. This type of cellular immunotherapy involves physicians extracting a particular type of white blood cell from the patient’s blood (T-cells) and then attaching them to one of these artificial receptors. Once these cells are infused back into the patient they begin to multiply, and with guidance from the receptor, recognize cancer cells that contain their same antigen.
This is a cancer therapy that was discovered in 1989 but has not yet been put into high gear until recently. It is already changing how patients with blood cancers that have not been responsive to previous therapy are being treated. Although the technology has been described almost three decades ago, clinical implementation has not occurred until recently. Even though CAR T-cell therapy is not well known to the general public, it has been speeding along the medical highway, with no rest stop in sight.
This rapid pace is of great value because hematological malignancies (blood cancers) are the fourth most common cancer in the United States. Non-Hodgkins Lymphoma is the most common of these in the United States and outcomes in aggressive and refractory subtypes are poor. Of this disease, the most common subtype is Diffuse Large B-Cell Lymphoma in which only small percentage of patients with relapsed disease or disease that was refractory to initial therapy is then cured with a stem cell transplant. Although this treatment has been approved for patients under the age of twenty-five with Acute Lymphoblastic Leukemia until recently this type of therapy had been restricted to smaller clinical trials for other very advanced and aggressive diseases.