CAR T-Cell Therapy News From ASH 2017

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Topics include: Treatment

What’s the latest news on CAR-T cell therapy from the American Society of Hematology (ASH) conference 2017 as we report on location from Atlanta? Expert Dr. Jon Arnason, from Beth Israel Deaconess Medical Center, shares new research released, which diseases the treatment can be used for, and when it’s appropriate to use. Tune in to hear how the clinical advances made in CAR-T cell therapy will impact patients with blood-related cancer.

Sponsored through a grant from Juno Therapeutics, Inc.

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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:

Hello, everybody.  This is Esther Schorr from Patient Power, and I'm here today in Atlanta at the ASH conference, the American Society of Hematology.  This is, if you don't know, it is the largest global gathering each year of researchers and clinicians that are studying blood cancers. And we're here at ASH speaking to researchers and physicians about all the findings that are happening here as a result of all the great research going on.  And actually this year is really exciting. 

And our interview today is with Jon Arnason. 

Dr. Arnason:

Perfect. 

Esther Schorr:

Why don't you tell our audience who you're with and what you specialize in, that would be great. 

Dr. Arnason:

Yeah, great.  So my name is Dr. Jon Arnason.  I work at Beth Israel Deaconess Medical Center in Boston.  My specialty is in lymphoma and hematological malignancies, and I run our CAR-T cell program there.  And that's really what we're pretty excited about at ASH this year. 

Esther Schorr:

Thank you.  So CAR-T cell, so it's not about cars, we know that.  We have a very diverse audience on Patient Power.  A lot of them may not know what CAR-T cell therapy is, so can you give us kind of the course 101 real quick about what that's involved with? 

Dr. Arnason:

Yeah, perfect.  So the concept behind it—CAR-T cells is short for chimeric antigen receptor T-cells, which is why we have a short term for it. And the concept behind it is that we know from a great vast experience that the immune system can be important for controlling certain cancers and that if there's a way to turn their immune system on, we can direct it towards cancers. 

And so a number of different groups have worked up a technology where they take immune cells from the patient through a blood collection, they genetically manipulate them so that the immune cells will be able to recognize the tumor, and then they inject the cells back into the patient.  And in a number of different cancers we've been able to see that those immune cells have been able to get the cancer under control for various amounts of time. 

Esther Schorr:

So it's really not some external a factor that is the treatment, but it's a combination of things of using your own immune system to target the cancer cells? 

Dr. Arnason:

Correct.  So there are a lot of immune therapies that have been used or are in development, and one of the issues with probably the most well-known is an allogeneic bone marrow transplant, where we give you a whole new immune system from somebody else.  That can control certain malignancies, but it also has the problem of having an out-of-control immune system that can attack the patient, and that's something called the graft-versus-host disease.

The beauty behind this technology, CAR-T cells, is that we're using the patient's own cells, and we're adding an element that allows it to recognize the cancer.  And through that strategy we're able to avoid a lot of the problems with nonspecificity that we see with graft-versus-host disease in patients who get an allogeneic bone marrow transplant. 

Esther Schorr:

Okay.  So I know that CAR-T cell therapy research has been going on for a while.  What's exciting this year? 

Dr. Arnason:

Yeah.  So I'm happy to remember the times when there were about 10 people in the only CAR-T session at ASH, and you knew all of them by name.  Now I actually have not been in a session where they haven't talked CAR-Ts, and so it's something that has been explosive in the last few years and something that is a gaining approval from the FDA and access to patients.  And so there's a lot of excitement about the diseases that it's currently approved in and a lot of enthusiasm about where it's going and how it can help patients in the future. 

Esther Schorr:

So just to clarify for our audience, which—which diseases, which blood cancers is it approved for and which ones are now the research looking at to head that way? 

Dr. Arnason:

That's a great question.  So there are two diseases that CAR-Ts are currently approved on.  The first is in pediatric ALL, and the second is in diffuse large B-cell lymphoma.

Esther Schorr:

And the research that's coming how, what are the new—what are the new areas? 

Dr. Arnason:

So basically if a there's a cancer, there's somebody working on trying to target it with CAR-T cells.  Part of the reason that CAR-T cells have been successful in ALL and in diffuse large B-cell lymphoma is because the targets there are isolated to the malignancy or cells that you can survive with having been eliminated.  So the CAR-T cells are very good at going to the tumor, eradicating the tumor, but they have to be targeting a particular target.  And the two approved CAR-Ts target CD19, which is expressed on the tumor but also on B cells.  B cells are the cells that make antibody. 

So the one common side effect of all of these CARs that a have been approved is that they eliminate your ability to make antibody, which in theory can put you at risk for infection.  We can fix that.  We can give patients antibody injections, so in a way we don't worry too much about that side effect. 

It becomes more complicated when you want to use CAR-Ts to target other cancers.  If you use them to target breast cancer or lung cancer, the target has to be only on the tumor cells and not on the healthy breast or the healthy lung or the healthy heart, because then you can have significant side effects.  So there's a lot of work to be done, and there's a lot of interesting strategies to sort of focus the T cells towards other tumors. 

Esther Schorr:

So you're trying to avoid collateral damage it sounds like.

Dr. Arnason:

That's exactly right.  In the case of B-cell malignancies the collateral a damage we can deal with, but if the T cells are damaging the heart, that can be rapidly very dangerous. 

Esther Schorr:

So we've got—you've got this information now.  Our audience has that information.  What should they do with it?  I mean, is there something that patients with hematological malignancies should be talking to their physicians, their medical team about now? 

Dr. Arnason:

Yeah.  So I think that's a really great question.  There's a lot of enthusiasm whenever there's a new treatment, and there's a lot of concern that if you're not getting the most recent treatment, you're not getting the best treatment.  I think it's important to emphasize that this technology, even in the approved indications, is at a very early stage.  There are only certain patients for whom it is appropriate to receive the treatment for these two diseases, diffuse large B-cell and ALL.  Standard treatments are very effective and need to be pursued first, and this is sort of a treatment of last resort. 

I think that as we gain more experience and as the CAR-Ts become more sophisticated as they evolve, it may be that we use them sooner in treatment of patients. But right now it's really something that your physician is going to realize when he's reached the end of what he can do with our conventional treatments that it's time to start thinking about CAR-Ts, either the approved ones or through a clinical trial. 

Esther Schorr:

I want to thank Dr. Jon Arnason for the insights about CAR-T cell therapy.  It's very, very exciting.  And I want to say to all of you, there will be more information coming from ASH 2017, and we wish you the best of health.  And as we say at Patient Power, 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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Page last updated on January 2, 2018