Published on November 28, 2017
During this Ask the Expert segment, Dr. Abdulraheem Yacoub from the University of Kansas Medical Center, responds to a community member question about CAR-T cell therapy. He explains how this treatment method works to target cancer cells in the body and what the future may hold for this therapy.
The Ask the Expert series is sponsored through an educational grant to the Patient Empowerment Network from Incyte Corporation.
Transcript | Is There a Role for CAR T-Cell Therapy in MPNs?
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Okay, Dr. Yacoub, here's a question we got in from Craig. Craig wants to know, “There's been a lot of buzz recently about CAR T-cell therapy, chimeric antigen receptor therapy. What is it, and might there be a role for it in the treatment of myeloproliferative neoplasms?”
All right. Well, this is a very exciting question, and we're very excited to have this new tool in our armamentarium in fighting cancer. So CAR-T cell therapies, CAR-T cells are basically immune-capable cells, CAR T-cells that we collect from the patient. And we inoculate it with a virus that carries a target that is directed towards the patient's individual cancer, and then we infuse the patient back with his own cells. And now those immune cells are more capable and more directed towards the cancer of choice, and that therapy would be very effective in treating certain cancers.
It is a very novel therapy that is evolving rapidly, and we're getting much and much better at doing it, and we're able to select better and better targets to fight. For this process to occur, we have to identify a specific cell marker on the cancer cell that we can allow the CAR-T cells to fight, and that marker has to be unique enough to the cancer that the immune cells will not fight the actual host, will not fight the patient.
So that has been the challenge in trying to find the right target for those cells to fight. They are very powerful cells when you release them, and they're very able to cause significant damage to the cancer if we find the right target.
So far the myeloid cancers, that's the M in myeloproliferative neoplasms, which include multiple families of cancers including acute leukemia and myelodysplastic syndrome and myeloproliferative neoplasms, the CAR-T cells have not yet been successful in those diseases just because we cannot yet identify the target on those cells that we can fight, and that target is unique enough to the cancer and different from the targets that the normal cells carry.
You do not want to use the immune system to fight the host. That would be—that can cause serious illness to the patient. So we're still trying to identify the right tool in how to use the CAR-T cells in fighting all cancers.
So far the only approvals for this were in acute lymphoblastic leukemia of children and adult large-cell lymphoma, which is a B-cell lymphoma. Those cells carry a specific target called CD19 which we can afford to fight and eliminate all these cells without causing harm to the patient. This has not yet been successful in any other cancer or approved in any other cancers just because we yet do not have the right antigen. However, the technology is evolving so fast that all these advances have been approved within the last six months or less.
So the future will hold a lot of hopefully success, and hopefully we'll be able to design specific CAR-T cells for any cancer of choice. And once we have that there is a high likelihood of cure with a capital C in patients with any cancer. But it's yet too soon to use this tool and this technology for patients with myeloid cancers and for patients with myeloproliferative neoplasms per se.
That was a very complete answer. Of course, we look forward to that coming day when we will have that target. Dr. Yacoub, thank you very much for explaining this.