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Where Is CAR T-Cell Therapy Leading Us?

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Published on April 23, 2021

How CAR T-Cell Therapy and Clinical Trials Are Improving CLL Care

How exactly does CAR T-cell therapy work? Will it eventually be the new standard of care for patients with chronic lymphocytic leukemia (CLL)? How are clinical trials changing the landscape of CLL treatment?

Hear the answers to these questions and more in this excerpt from a recent CLL Town Hall event. Hosts Andrew Schorr and Michele Nadeem-Baker talk to Dr. Deborah M. Stephens, DO, of the Huntsman Cancer Institute at the University of Utah, and Dr. Shuo Ma, MD, Ph.D., of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, about the status of CAR T-cell therapy research and how clinical trials are improving patient care.

Support for this series has been provided by AbbVie Inc., Genentech, Inc. and Adaptive Biotechnologies. Patient Power maintains complete editorial control and is solely responsible for program content.

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Transcript | Where Is CAR T-Cell Therapy Leading Us?

Andrew Schorr: CAR T, chimeric antigen receptor, T-cell therapy.

How Is CAR T-Cell Therapy Changing the CLL Treatment Landscape?

Dr. Stephens: Yes, this is the really exciting new treatment. And just so everybody understands what it is, essentially, it's a treatment that uses your own immune system, kind of modifies your own immune system to help your own body attack your CLL cells. So essentially you go in, you get blood collected. We take your T-cells, which is a really important part of your immune system. In the lab, we essentially – it's like training an army. We put in a vector that makes your, those T-cells really want to go after CLL cells. And then we essentially give you some additional chemotherapy to knock the immune system down a little bit, so it won't reject those cells when we put them in, then we put them back in, and the cells go to work. So, we've essentially trained an army of your own immune system to help fight off the cancer.

So, I think this is really exciting. It's still only available on clinical trials, although I see really clearly that the companies who make these, manufacture these cells are pushing to make this more of a standard of care. Meaning hoping to get it approved by the FDA sometime in the next year or two. But what's exciting about it, it's really kind of a completely different approach. We talk about using these pills or chemotherapies to target something – we're just, essentially, helping your body to fight itself. And so it’s a really, it's a different method. Often when people have had multiple different types of therapy, maybe they've had chemotherapy with FCR, then they had ibrutinib (Imbruvica), then they had venetoclax (Venclexta), and they've relapsed after all of these therapies, I think this is a really exciting approach.

Another thing that's really exciting about it is, previously, we would do more of something called a bone marrow transplant or a stem cell transplant. And that's a really involved procedure that's not typically... a lot of people that have CLL are not candidates for that aggressive of a procedure, just because most people, maybe they're older than age 65 or they have other medical problems that they just can't tolerate it. Something like a bone marrow transplant might be so toxic it could potentially kill someone, and so we have to be really cautious in who we recommend to. But in order to do a bone marrow transplant, your CLL actually has to be in remission. And so if we can't get you into remission, then we can't do a stem cell transplant or a bone marrow transplant. What's different about a CAR T is you don't have to be in remission.

In fact, the majority of people are not in remission when they go into CAR T. And I think it’s just, it's a little bit too early to understand what are really the long-term side effects. And it's not yet for people who are newly diagnosed with CLL, just because there are a lot of side effects with, when you stimulate the immune system, you can get a lot of side effects that are... that can be dangerous. And so it's not something we're widely recommending to everyone, by any means right now. But it's very exciting and it's really interesting, especially for patients who have relapsed or don't have any of our standard treatment options available.

Andrew Schorr: So Dr. Ma, just as we end this section, what do you want to say to our audience? We'll talk more in the Q&A, but about considering being in a trial, with all the stuff you're talking about?

How Are Clinical Trials Improving CLL Care?

Dr. Ma: Right. So I think from the overall CLL future point of view, we cannot move the field without testing new drugs. All of the wonderful new drugs we have benefited today are coming from prior clinical trials, so participating in clinical trials is absolutely important for us to move the field forward. But from individual point of view what is the benefit, right? I think you can—we should say that the clinical trial really provides the highest standard clinical care. Besides having the opportunity to get potentially new drugs, and the only reason why we typically run that clinical trial is because we believe, based on preliminary data, there's a lot of potential for those new drugs and new combinations. And as a potential, that might potentially move the standard of care or it may be even better than clinical... than standard of care. However, we can't say that without actually doing a clinical trial to compare them side by side. For example, the Phase III clinical trials.

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