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What does CAR-NK mean for CLL patients?

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Published on July 9, 2020

Currently in clinical trials for CLL, CAR-NK is a new immunotherapy using cord cells to recognize and kill cancer cells. Dr. Nitin Jain, MD Anderson, and Patient Power host, Andrew Schorr discuss this promising new therapy. Hear Dr. Jain explain how during the trial, CAR-NK (chimeric antigen receptor natural killer cell) showed the potential to kill off cancer cells quickly, and without the toxicity or side effects of other treatments.

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Transcript | What does CAR-NK mean for CLL patients?

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.

Andrew Schorr:

Hello, and welcome to Patient Power. I'm Andrew Schorr with Dr. Nitin Jain, a CLL researcher and clinician at MD Anderson Cancer Center in Houston. Dr. Jain, we know that there's research going on for CAR-T cell therapy in CLL, chimeric antigen receptor T-cell therapy. And I personally know people who have been in these trials. But at MD Anderson, you're also doing research in CAR NK trials. So could you explain the difference and what do we know so far?

Dr. Jain:

Sure. Yeah. So just to kind of elaborate on the background a bit. So CAR T-cell is a therapy, which is actually not FDA approved, not yet for CLL, but for non Hodgkin's lymphoma, as well as for acute lymphoblastic leukemia in kids where the T-cells, which are one of the immune cells in our body are basically taken from a patient they're taken to the lab where these T-cells are isolated and then a genetic manipulation is done in these T-cells to make these T-cells very specific to kill cancer cells. And this happens by introducing a gene called CD 19. So basically, and when you give those T-cells= back to the patient, these T-cells, which are their own cells, and they basically are genetically modified coming back to the patient themselves to the same patient again, they're basically like killers and they just kill the cancer cells.

And that is what, as I mentioned, is FDA approved for patients with lymphoma, for patients with acute lymphoblastic leukemia. And hopefully eventually we'll have some approval for CLL as well, but that's not the case at this time. So the investigators at our institution, and this is the work actually led by Dr. Katy Rezvani in our STEM cell transplant group, as well as Dr. Elizabeth J. Shpall, both at the STEM cell transplant group, kind of hypothesized that we use T-cells as a backbone here to make the CARs, but can you use NK cells? So NK stands for natural killer cells. So that's another class of immune cells. All of us have them, all of us have some percentage of NK cells in our blood circulating. So what Dr. Rezvani’s group did was they isolated these NK cells, not from the patients. They did some work in that, but what they did was they used cord blood cells.

So when the baby's gone, the cord from the mom, the cord bloods are stored or can be stored. And those cord blood units have NK cells in them. So they use those to derive and kill cells. And then those NK cells were then... The same genetic manipulation is done on those NK cells in terms of a gene is introduced. And then those NK cells are given to a patient as part of a clinical trial. So that's what Dr. Rezvani group did. And what they showed in their publication last year in New England Journal of Medicine is that they treated several patients with CLL, several patients with Richter's transformation, which is an aggressive transformation of CLL, and some other patients with non Hodgkin's lymphoma that they saw a majority of the patients achieving a remission at one month mark. And then many of those patients subsequently received other therapies.

For example, they may have received venetoclax (Venclexta) or other therapies to control their disease, or make sure the disease doesn't come back. So that has created a lot of excitement in the field that whether you can use NK cells as a cell from which you make CAR, rather than the T-cell, which is kind of what has been the standard so far. And I think notably one important point to mention here would be that they saw very limited, if any, cytokine release syndrome, which is one of the side effects which can with CAR T-cell therapy and also neurotoxicity, which is also another side effect which can occur with CAR T-cell therapy. So those are kind of an excitement in the field. And I think now our group, and obviously Dr. Rezvani is leading it, they're trying to further enroll more patients to mother modifications of the gene construct to say, and several other groups have also not started working on this concept of CAR NK.

Andrew Schorr:

Okay. So the idea is, can we have sort of an immunotherapy in a way using your own cells to fight the cancer and if you're using NK cells, can it have fewer side effects?

Dr. Jain:

Correct. Correct. Correct.

Andrew Schorr:

Okay. Well, we will be talking to Dr. Rezvani in another program and we'll get an update directly from her. Thank you as a clinician for putting it in perspective for us, Dr. Nitin Jain, we always are delighted to have you with us.

Dr. Jain:

Thank you. Take care, Andrew.

Andrew Schorr:

All right, Andrew Schorr. As we look at where science is headed, for those of us living with CLL, whether it's CAR T or CAR NK be in our future, it's good to know they're working on it and that these have promise for us. Remember, knowledge can be the best medicine of 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.

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