CAR T-Cell Therapy: Is It Right for You?

For a long time, doctors typically relied on chemotherapy, radiation or surgery to treat cancer. But, with advances in targeted therapies and immunotherapy, patients have more options than ever before. CAR T-cell immunotherapy is one of those very exciting developments.

“CAR T-cell immunotherapy allows us to offer patients a potentially curative intervention,” explains Jonathon Cohen, co-director for the lymphoma program and practitioner in the Department of Hematology and Medical Oncology of Emory University. “This is something that we hope will be applicable to a large number of our patients.”

“This is an ever-expanding topic,” adds Jean Koff, a hematologist who specializes in treating lymphoma at Winship. “It’s important that we stay on top of all the new data that’s coming out and in all the new ways we can help our patients access these novel and effective therapies.”

Learn more about CAR T-cell therapy and if it may be a good option for you.

CAR T-cell therapy is typically used to fight certain blood cancers, including lymphoma and leukemia. Recently, the FDA approved it for use in some people with multiple myeloma, thanks in part to a clinical trial that took place at Winship Cancer Institute.

It is important to note that CAR T-cell therapy isn’t right for everyone. Typically, lymphoma patients eligible for CAR T-cell therapy have gone through at least two other therapies, but there are trials ongoing to explore its use throughout a patient’s disease course.

Currently, CAR T-cell therapy is approved by the FDA for:

• Adults with relapsed or refractory multiple myeloma (and have completed at least four previous treatments).
• Adults with relapsed or refractory B-cell lymphomas, including diffuse large B-cell lymphoma, mantle cell lymphoma, and follicular lymphoma.
• Adults and children with relapsed or refractory acute lymphoblastic leukemia.

One of the most promising aspects of CAR T-cell therapy is that it’s an option for certain patients who have tried (unsuccessfully) other treatments.

“We know that non-Hodgkin lymphoma patients who don’t respond to initial chemotherapy, or who relapse after frontline therapy, often have a very poor prognosis,” explains Dr. Koff. “CAR T-cells have really risen to the forefront in treating those type non-Hodgkin’s lymphomas and giving hope to more people.”

CAR T-cell therapy is also offering more options to some individuals with multiple myeloma, a complex cancer to treat. It often comes back, and its therapies can bring serious side effects.

The recent clinical trial that led to FDA’s first approval of CAR T-cell for multiple myeloma (and in which researchers at Emory participated) found that idecabtagene vicleucel (ide-cel) improve myeloma in 72% of patients who did not have any meaningful treatment options. Additionally, 28% of participants’ myeloma disappeared completely. These responses are long-lasting in some patients.

“CAR T-cell therapy represents a major advance for patients with myeloma,” says Jonathan Kaufman, MD, medical director and section chief of Ambulatory Infusion Centers at Winship Cancer Institute. “With this first of hopefully more approaches harnessing the immune system, we now have a treatment option for patients that can provide years of remission without ongoing treatment.”

Side effects from CAR T-cell therapy can be serious. Your doctor and care team will closely monitor your treatment and look for any signs of complications. Serious side effects can include:

• Cytokine release syndrome (CRS): Inflammatory syndrome that can lead to a serious shock-like syndrome. Symptoms of CRS include fever, vascular leakage and organ dysfunction. Although this can be serious and may require treatment in the ICU, it can be treated with tocilizumab or corticosteroids.
• Neurotoxicity: Problems in the nervous system can range from mild headaches and confusion to more serious conditions, like seizures, memory loss or cerebral edema. Symptoms can be managed with corticosteroids.

Other side effects of CAR T-cell therapy may include:

• Allergic reactions.
• Weakened immune system.
• Low blood cell counts.
• Abnormal levels of minerals (potassium, sodium) in the blood.

There are many treatment options for individuals with blood cancers – including those that may be eligible for CAR T-cell therapy. The best thing you can do is educate yourself and have an open and honest conversation with your doctor. Together, you can discuss the pros and cons of CAR T-cell therapy. And remember, if you’re not getting the information and insight you deserve, you can always seek a second opinion.

Our cancer care team at Winship Cancer Institute is on the leading edge of exciting new therapies, including CAR T-cell therapy. We regularly work with our patients – including those looking for a second opinion – and advise them on the best path forward. Learn more about our approach and cancer care innovations.