CAR T-Cell Therapy: Procedure, Prognosis & Side Effects – Cleveland Clinic

OverviewMan seated in chair for CAR T-cell cancer treatment.What is CAR-T cell therapy?

Chimeric antigen receptor (CAR) T-cell therapy treats certain cancers by turning your T lymphocytes or T cells into more efficient cancer-fighting machines. While researchers are still collecting long-term data, CAR T-cell therapy is proving to be a very effective way of treating certain blood cancers.

Your T cells are white blood cells in your immune system. Your immune system monitors your body for intruders, including cancer (and also infected or other abnormal cells), by tracking proteins called antigens. Antigens are located on intruder cells surfaces. Your T cells have their own proteins called receptors. Receptors are like the anti-virus software on your computer. When your T cell security team senses intruder antigens, they use their receptors to catch and block the intruders. More than that, your T cells can kill the intruder cells.

But intruder antigens have their own form of protection. They can disguise themselves to hide from your T cells. CAR T-cell therapy ensures your T cells can get past intruder antigen disguises or defenses.

The U.S. Food and Drug Administration (FDA) has approved several CAR-T cell therapies for people who have certain blood cancers that dont respond to chemotherapy and other treatments. This therapy is also used to treat people who have blood cancer that returns after other successful treatments.

CAR-T cell therapy is offered through special programs called risk evaluation and mitigation strategies (REMS). REMS ensure healthcare providers are certified to provide the therapy and have the know-how to manage any serious side effects.

Here is information on the cancers now treated with CAR-T cell therapy:

B-cell non-Hodgkin lymphoma, including:

Diffuse large B-cell lymphoma (DLBCL).

Follicular lymphoma with DLBCL.

High-grade B-cell lymphoma.

These conditions are usually treated with chemotherapy, monoclonal antibodies and stem cell transplant.

Tisagenlecleucel.

Axicabtagene Ciloleucel (pronounced AK-see-KAB-tuh-jeen sy-lo-LOO-sel). Brand name: Yescarta.

Researchers are investigating whether CAR-T cell therapy can help people who have other cancers like breast cancer, brain cancer and lung cancer.

CAR-T cell therapy is a relatively new treatment. As of 2019, 130 U.S.-based medical centers were authorized to provide it. All told, those centers had treated fewer than 2,000 people with CAR-T cell therapy.

The CAR-T cell process starts with collecting your blood. Heres a step-by-step explanation:

Most people need to stay in the hospital for a week to 10 days so their healthcare providers can monitor their response to the treatment and treat any side effects. You may be able to receive your CAR-T cells without staying in the hospital. If thats your situation, your healthcare providers will still monitor your progress and the process. If you have side effects, you may need to return to the hospital to complete your treatment.

Healthcare providers and regulatory agencies evaluate CAR-T cell therapy on a case-by-case basis. Generally speaking, the U.S. Food and Drug Administration (FDA) approves these therapies after clinical trials show significant success in treating specific cancers.

For example, the FDA recently approved CAR-T cell drug idecabtagene vicleucel (Abecma) to treat multiple myeloma after a clinical trial showed this treatment partially or completely shrank tumors in 72% of people participating in the trial. The treatment effect lasted about 11 months.

CAR-T cell therapy isnt perfect. Sometimes, CAR-T cell therapy doesnt kill cancer cells as expected. Sometimes, the treatment works, but the cancer comes back. Some reasons why CAR-T cell therapy may not work include:

Like most cancer treatments, CAR-T cell therapy has side effects that can, at times, cause serious life-threatening problems. The two most common side effects are cytokine release syndrome and neurological problems.

Cytokine release syndrome (CRS) can happen after youve received your CAR-T cells and they start multiplying and attacking cancer cells. Cytokines are chemicals that trigger your immune system. When your CAR-T cells start to work, your immune system may respond by releasing large amounts of cytokines into your bloodstream. Most of the time, CRS happens in the first week or two after treatment.

If you have this syndrome, you may feel as if you have the flu. CRS symptoms include:

CAR-T cell therapy can affect your nervous system, causing symptoms that happen in the first few weeks after your treatment. Some symptoms can affect your ability to drive or operate machinery, so you should plan to avoid those activities for eight weeks after your treatment. Neurological symptoms include:

CAR-T cell therapy can cause significant or life-threatening side effects. Thats why healthcare providers usually require people who have this treatment to stay in the hospital for several days so healthcare providers can monitor and manage any side effects.

For the first month after treatment, you should plan on having someone with you 24 hours a day. You should also plan on staying within driving distance of your treatment location. And you should plan on having someone drive you where you need to go for two months after treatment.

Its still early days for CAR-T cell therapy, but studies continue showing positive results. For example, a 2020 study tracked children who had acute lymphoblastic leukemia (ALL). More than 85% of the children with ALL had complete remission right after treatment and 60% of those children remained free of cancer 12 months after treatment.

And, researchers are aggressively pursuing new insight into CAR-T cell therapy. As of March 2020, CAR-T cell was the focus of more than 800 studies. Examples of current research include:

CAR-T cell therapy has significant side effects. Once youre home from the hospital, you should monitor changes in your body and contact your healthcare provider if you develop side effects.

CAR-T cell therapy is expensive. It can cost healthcare providers up to $1 million to treat one person. The amount you may need to pay for treatment depends on your individual circumstance, such as your insurance coverage and whether you qualify for Medicare. If your healthcare provider recommends CAR-T cell therapy, theyll probably suggest that you work with hospital financial advocates to understand your specific situation.

A note from Cleveland Clinic

CAR-T cell therapy is breaking new ground and bringing new hope for some people who have certain blood cancers that dont respond to chemotherapy or other initial treatments. Its also used for people whose blood cancer has come back. But CAR-T cell therapy has potentially life-threatening side effects. And while it helps many people, its too soon to say if CAR-T cell therapy can cure the blood cancers that it targets. If you have blood cancer, ask your healthcare provider if your cancer might be treated with CAR-T cell therapy.

Read more from the original source:
CAR T-Cell Therapy: Procedure, Prognosis & Side Effects - Cleveland Clinic