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What Is CAR-NK Cell Therapy?

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Published on October 22, 2020

Will CAR-NK Cell Therapy Replace CAR T-Cell Therapy?

CAR-NK cell therapy is an exciting new experimental treatment option in which Chimeric Antigen Receptors equip Natural Killer cells with the ability to recognize, target and kill cancer cells. This advanced technology may also be able to provide the results of CAR T-cell therapy without the high toxicity and risk of graft-versus-host disease.

Join us as Patient Power Co-Founder and Two-Time Cancer Survivor Andrew Schorr hosts Dr. Katy Rezvani from MD Anderson Cancer Center to discuss the details of CAR-NK therapy, how it works, and what it could mean for ALL, CLL, and NHL patients moving forward. Dr. Rezvani is a professor, director of Translational Research, and Chair in Cancer Research at MD Anderson.

 

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Transcript | What Is CAR-NK Cell Therapy?

Andrew Schorr:
Hello and welcome to Patient Power. I'm Andrew Schorr, a patient living with two blood cancers; chronic lymphocytic leukemia and myelofibrosis. And of course, we've known for years about stem cell transplant, but there's all kinds of new cellular therapy, if you will, that's going on. And with us is an expert in that. Joining us from MD Anderson Cancer Center in Houston is Dr. Katy Rezvani. What is your title there, Dr. Rezvani?

Dr. Rezvani:
I'm a Professor of Medicine in the Department of Stem Cell Transplant at MD Anderson Cancer Center. I am also Chief of Section of Cell Therapy in the Department of Stem Cell Transplant and the Medical Director of our GMP facility. I run a research lab and so I'm also Director of Translational Research.

Andrew Schorr:
Okay, well that's exactly what we're talking about now. You've been really leading a lot of work-related to chimeric antigen receptor NK therapy.

Dr. Rezvani:
That's correct.

What are CAR-NK Cells?

Andrew Schorr:
What are NK cells?

Dr. Rezvani:
Sure. Natural killer cells or NK cells are part of our immune system. They patrol our bodies continuously and they look for abnormal cells like cancer cells or virally infected cells and they destroy them. They're part of a subset of immune system that we call the innate immune system, which means that they're the first line of defense, really against cells becoming abnormal. On a per-cell basis, natural killer cells are the most effective killers of cancer cells in our body.

Andrew Schorr:
Okay. The idea that we have these warriors and so you're trying to harness them to go to war against the cancer we have.

Dr. Rezvani:
Absolutely.

What is the Source of NK Cells for CAR-NK Therapy?

Andrew Schorr:
Now, so how do you do that? Where do you get NK cells from?

Dr. Rezvani:
The source of natural killer cells that we use for our preclinical and our clinical studies is cord blood. At MD Anderson, we're fortunate enough to have a cord blood bank that was established by my colleague and close collaborator, Dr. E.J. Shpall, she established this bank when she joined MD Anderson nearly 20 years ago. There are many tens of thousands of units of umbilical cord that were altruistically donated by women who were having babies in the surrounding hospitals.

Now, other groups are also looking at other sources of cells for natural killer cells. For instance, you can get natural killer cells from a healthy donor. Let's say for instance, a relative. Natural killer cells can be grown from stem cells. Either from cord blood stem cells or a specialized type of stem cells known as induced pluripotent stem cells or IPSCs. And also, natural killer cells can be derived from cell lines.

Andrew Schorr:
That's where the cells come from for what you're doing. If I were going to receive them, my understanding is first I would have some chemo to prepare my body to receive the NK cells, the natural killer cells, that you've taken from cord blood. Right?

Dr. Rezvani:
But of course, before we infuse the cells, we have to generate the cells. We get the cord blood unit from our bank, which are frozen. We thaw the cells and then we engineer these cells in a specialized facility known as good manufacturing practice, or the GMP facility here at MD Anderson. And the purpose of that is to introduce the gene for the chimeric antigen receptor into our natural killer cells.

What we're trying to build really is on the ability of the natural killer cells to kill cancer cells by giving them the skills to recognize and destroy cancer cells even more effectively. And that's especially relevant because cancer cells develop ways to hide and camouflage themselves from recognition by the immune system. The whole idea of introducing chimeric antigen receptor into an NK cell, or even a T-cell, is to endow these NK cells and T-cells with the ability to recognize the cancer cell. It's like turning them into heat-seeking missile.

What Makes Someone a Candidate for the CAR-NK Trial?

Andrew Schorr:
Who would be right for a study like this?

Dr. Rezvani:
Patients with chronic lymphocytic leukemia, patients with non-Hodgkin lymphoma patients or patients with acute lymphoblastic leukemia that have received standard treatment, either for instance, chemotherapy or targeted therapy or a transplant and that have failed and progressed. After two lines of treatment will be eligible for our trial.

Andrew Schorr:
How durable is this? How long does it work?

Dr. Rezvani:
Yeah, that's an excellent question. And in the first group of patients that we treated, because these patients had very advanced disease, we had one patient who had progressed through 11 lines of therapy, including a transplant, an autologous stem cell transplant. We allowed the patient’s doctor together when the patient, make a decision as to whether once the patient responds and goes into remission, whether they just want to "watch and wait" or whether they want to give additional treatment to the patient. For instance, if a patient has had very bad disease, very refractory disease and we know that normally these patients would benefit from transplant, but this patient could never get to a transplant because his or her disease was very aggressive. Once we got them into remission with CAR-NK cells, they were allowed to then receive a transplant.

In terms of the duration of response in the absence of any additional therapy, I cannot really comment on that because many of our patients, once they got into a remission, their doctors decided, okay, this is my opportunity then to give maybe additional treatment to the patient to make sure they stay in remission. With the current expansion of the study, what we are doing is giving CAR-NK cells to the patient now that we feel more comfortable with the response and we are going to watch and wait and follow the patients. And hopefully, we will find that our responses are durable.

Andrew Schorr:
Dr. Katy Rezvani, researcher and helping lead the way at MD Anderson, thank you for being with us.

Dr. Rezvani:
Thank you so much for giving me this opportunity to share our work with you. I appreciate it.

Andrew Schorr:
I'm Andrew Schorr. Remember, knowledge can be the best medicine of all.


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