CAR T-Cell Therapy: Who Might Benefit?

Chimeric antigen receptor (CAR) T-cell therapy is a new way to treat cancer. It’s a living drug made from T cells, white cells that are an important part of your immune system. After specialists change the T cells in a lab, the cells are put back into your body to find and kill cancer cells.

This kind of therapy may work when other treatments haven’t. It’s not right for everyone. But the number of cancers T-cell therapy treats has grown over the last few years.

Before recommending this treatment, your doctor will consider:

• What type of cancer you have
• Which treatments you’ve already had
• Your overall health

Who Might Get CAR T-Cell Therapy?

The FDA has approved five CAR T-cell therapies:

• Axicabtagene ciloleucel (Yescarta)
• Brexucabtagene autoleucel (Tecartus)
• Idecabtagene vicleucel (Abecma)
• Lisocabtagene maraleucel (Breyanzi)
• Tisagenlecleucel (Kymriah)

CAR T-cell therapies are approved to treat these types of cancer:

• B-cell precursor acute lymphoblastic leukemia (ALL) in children and young adults up to age 25
• Diffuse large B-cell lymphoma (DLBCL)
• Primary mediastinal large B-cell lymphoma
• Large B-cell lymphoma transformed from follicular lymphoma
• High grade B-cell lymphoma
• Aggressive B-cell lymphoma not otherwise specified (NOS)
• Follicular lymphoma
• Mantle cell lymphoma
• Multiple myeloma

Is CAR T-Cell Therapy Right for Me?

CAR T-cell therapy is for people who’ve tried two or more treatments, but their cancer hasn’t improved or has come back.

“Most of these patients have few, if any, effective treatment options available,” says David Porter, MD, the Jodi Fisher Horowitz Professor in Leukemia Care Excellence at the Hospital of the University of Pennsylvania.

Studies are showing that there’s a benefit to starting CAR T-cell therapy even before you’ve tried two other treatments.

“I think we will be seeing more and more earlier application of these cells,” says Porter, who is director of cell therapy and transplantation at the hospital.

CAR T-Cell Therapy for Other Cancers

This treatment is still very new. Doctors have to learn more about it before they can use it earlier in the disease or to treat more types of cancer. They learn about CAR T-cell therapy by testing it in clinical trials. In these studies, researchers use new drugs or treatments with small groups of people to see how well they work.

Studies are looking to see whether it might be right for other blood cancers. Other studies are trying to find out if CAR T-cell therapy might work against solid tumors such as:

• Lung cancer
• Ovarian cancer
• Breast cancer
• Prostate cancer
• Liver and kidney cancer
• Stomach cancer
• Pancreatic cancer
• Colon cancer

“These are still at the very early stages, but a few CAR-T products look promising,” says Sattva Neelapu, MD, professor in the Department of Lymphoma and Myeloma at The University of Texas M.D. Anderson Cancer Center in Houston.

He says it’s harder to treat solid tumors than blood cancers. That’s because the substance that T cells target is also found in some normal tissues. The altered T cells might kill healthy tissue by mistake and cause side effects.

When CAR T-Cell Therapy Might Not Be the Right Choice

There aren’t any guidelines to keep you from getting this type of therapy if it’s approved for your age group and your type of cancer. But because it can cause serious side effects, it may not be a good choice for people with other health problems like heart disease or chronic kidney disease.

“We have to evaluate those types of patients on a case-by-case basis to see which ones might qualify,” Neelapu says. Your doctor will do tests to make sure you’re healthy enough for this treatment.

CAR T-cell therapy also isn’t best for people with a fast-growing cancer. “Patients with rapidly growing disease don’t seem to do as well and have more side effects,” Porter says. With a fast cancer, you can’t afford to wait 3 to 4 weeks for the lab to prepare your T cells.

How You Can Try This Treatment

“CAR T-cell therapy doesn’t work for everybody. But when it does work, it can work dramatically,” Porter says.

Some people who received CAR T-cells in studies have been in remission for more than 10 years. Despite this success, he says not everyone who could benefit from this treatment gets it.

Taking part in a clinical study of CAR T-cell therapy could give you or your child the chance to try this treatment before it’s approved for your cancer. But you have to find the right study.

“There are lots of resources for people who might be interested in looking into clinical trials,” Porter says. One of the best ones, he says, is the U.S. National Library of Medicine’s clinicaltrials.gov website.

Porter also suggests that you ask your health care team to connect you with a clinical trial of CAR T-cell therapy in your area. Or check with an advocacy organization like the Leukemia & Lymphoma Society.

If there’s a clinical trial for your type of cancer, you still need to qualify for it. The study’s doctors will make sure you’re healthy enough to benefit from the therapy.