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The Science Behind Immunotherapy for ALL

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Published on February 27, 2020

Key Takeaways

“It’s harnessing the power of our own immune systems to fight cancer,” says Dr. Patrick Brown, speaking about the use of immunotherapy in treating acute lymphoblastic leukemia (ALL). Dr. Brown, an ALL expert from the Kimmel Cancer Center at Johns Hopkins, joined Patient Power Co-Founder Esther Schorr at the 2019 American Society of Hematology (ASH) Annual Meeting & Exposition. 

In this video, Dr. Brown explains the science behind immunotherapy, and provides examples of how different types of immunotherapy work. Watch now to learn from an ALL expert.

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Transcript | The Science Behind Immunotherapy for ALL

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Esther Schorr:         

So, there are a lot of acronyms going on around, especially ALL and some of the new therapies, there are FLT3 and BiTEs and all these kinds of—can you just give us a little primer on that?

Dr. Brown:               

Sure. I know—I know it can be confusing.

Esther Schorr:         

Yeah. 

Dr. Brown:               

So, probably one of the major advances in the last five years in medicine has been the advent of immunotherapy for many cancers.

Esther Schorr:         

Right.

Dr. Brown:               

And in ALL the immunotherapy that has proven successful for cancers involves antibodies and other things that target specific proteins on the surface of the cells. And so many of the acronyms that you hear, BiTEs and CARs and ADCs are just different versions, different technologies of immunotherapies that target proteins on the surface of the leukemia cells. 

So, BiTEs, for example, stands for Bi-specific T-cell Engaging antibody. And the way that works is, it’s an antibody that has two different pieces to it; one piece latches onto the leukemia cell, and one piece latches onto our normal functional T cells, brings them together and induces a cytotoxic killing response. 

Esther Schorr:         

Whoa.

Dr. Brown:               

And so, it’s harassing the power of our own immune systems to fight cancer by engaging our normal T cells, which are programed to killed. It’s just that they are programmed to only kill cells that are infected, for example, which is a healthy response. 

Esther Schorr:         

Right. 

Dr. Brown:               

And turning them into killers of leukemia cells. And so, BiTEs is the technology that brings together tumors and T cells and BiTEs—the first BiTEs that have been successful are in ALL targeting CD19, but other BiTEs are coming along to target other proteins and other cancers. 

Esther Schorr:         

So—and this is a different approach to therapy than, say, CAR T.

Dr. Brown:               

Exactly. So, CAR T cells are the same idea. It harasses the power of T cells to kill leukemia. But CAR-T cells require basically the harvesting of our own T cells from us, engineering in the laboratory and then re-infusing back into the patient. And so, that’s… 

Esther Schorr:         

…that’s complicated.

Dr. Brown:               

That process is complicated. It’s very effective, but it ends up with the same general reaction at the—at the end, which is the linking of a functional T cell to a leukemia cell and killing it. 

Now, that advantage of BiTEs is that they are—they don’t require that process, so they’re in the pharmacy and able to be used off the shelf, if you will.

Esther Schorr:         

Mm-hmm.

Dr. Brown:               

The disadvantage is that they rely on the power of our own endogenous T cells unmanipulated. And for some patients, their T cells are not that healthy, particularly because of how we’ve been using the bites. We’ve been using chemotherapy first, followed by the BiTEs. And you can imagine that the chemotherapy can, kind of, cripple our normal T cells.

Esther Schorr:         

Wow. 

Dr. Brown:               

And make them unable to be engaged. And, so, one of the strategies for bringing the response rates with BiTEs up to par with that that’s seen with CAR-T cells is to try to figure out when in the disease process to use the BiTEs so that our own T cells are as healthy as possible and can be engaged.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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