On April 6, 2016, we discussed several new successful treatments against cancer in the Minnesota Spokesman-Recorder article “Good news: We are winning the war on cancer.” This is an update on one of those treatments we referred to then as combination cell, or chimeric cell, therapy.
Researchers and reporters alike are now calling it “living cell therapy.” It works well and has been approved to treat certain resistant childhood leukemias and adult lymphoma. Unfortunately, results against solid tumors are not yet favorable. Success rates as an FDA-approved treatment is greater than 70 percent, which is remarkable considering that, in the recent past, these cancers, failing traditional therapies, were incurable.
There are particular types of immune cells called T-cells that are the real powerhouses when it comes to fighting disease and cancer. Doctors can perform a pretty slick trick where they extract a T-cell from a patient’s body and mix it with a specific virus. That is why it has been called combination cell, or chimeric cell, therapy.
This virus infects the T-cell and directs it to produce unique sticky proteins on its surface that recognize novel proteins on the cancer cells. They fit together like hand and glove. These living therapy T-cells float freely in the blood and recognize blood-born malignancies. They bind to the malignant cells in the blood and obliterate them.
This type of living cell therapy works best for specific blood-borne malignancies, especially those of the liquid form, such as leukemia and lymphoma. Here’s how it works:
Leukapheresis
Special immune T-cells are isolated from a patient’s blood using a particular filter. These cells are then frozen and sent to a unique laboratory that transforms them into living treatment cells.
Cell programming
In the lab, the T-cells are mixed with a specific virus that causes the T-cells to make unique proteins on their surface that can later recognize and stick to leukemia or lymphoma cancers cells.
Multiplication
These newly programmed T-cells are grown and multiplied over a million-fold in the laboratory, so they are in large enough numbers to fight cancer when they are needed later.
Quality review
The new group of programmed and multiplied cancer-fighting T-cells are specially checked and screened to make sure that they have only the desired cells with unique cancer-fighting properties.
Lymphocyte reduction
The number of lymphocytes in the patient is reduced so that when a large number of the newly programmed lymphocytes (originally from the cancer patient, but now grown to much larger numbers) can be more easily given back to and accepted by the patient and can function at optimal levels.
Living cell drug infusion
The newly programmed cancer-fighting T-cells are slowly injected back into the cancer patient. This is done over several minutes.
Cancer cell death via cytokine storm
The cancer-fighting T-cells can sense what size job they need to do and can increase their numbers even more inside the body, if needed. They can then launch an all-out attack on the cancer cells, killing them.
During this attack, the cancer-fighting cells release many substances called cytokines that enable the most effective attack. This release is called a cytokine storm. It usually occurs one to two weeks after the T-cells are injected back into the cancer patient.
The cytokine storm can make the patient feel like they have the flu. Oddly, that is considered a good sign, except in a few cases where the storm can be so severe it can harm or even kill the patient. Doctors are getting better and better at treating and handling the storm, so most patients do well.
A costly process
The process of transforming normal immune T-cells into cancer-fighting cells is called CAR-T production, for “Cancer Antigen Receptor T-cells.” It is an extremely expensive process: Currently, the cost to produce CAR-T cells for injection is just short of $500,000 per treatment. Prices may come down as the techniques to develop CAR-T cells improve.
Additionally, researchers are devising ways to make the CAR-T cells recognize multiple targets on cancers cells rather than the single target employed now. The ability to identify various targets on a cancer cell will make the CAR-T cells more efficient and will increase the number of successful treatments. There are over 50 CAR-T studies underway.
In conclusion
Although the war on cancer is not over, I’m delighted to report that right now we have some of the best tools ever available in the fight. In fact, former president Jimmie Carter used some of these tools to have a complete remission of malignant melanoma that metastasized to his brain.
If you or a loved one is diagnosed with cancer, it’s not the same prognosis that it was even a few short years ago. Talk to your physician about a combination of therapies including traditional surgery, radiation, and chemotherapy along with the new strategies including CAR-T living drug cancer treatments and many other new cancer therapies.
The war on cancer has never looked better than it does today.
Charles E. Crutchfield III, MD is a board-certified dermatologist and clinical professor of dermatology at the University of Minnesota Medical School and a Benedict Distinguished Visiting Professor of biology at Carleton College. He also has a private practice, Crutchfield Dermatology in Eagan, MN.
He received his MD and Master’s Degree in molecular biology and
genomics from the Mayo Clinic. He has been selected as one of the top 10 dermatologists in the United States by Black Enterprise magazine. Minnesota Medicine recognized Dr. Crutchfield as one of the 100 Most Influential Healthcare Leaders in Minnesota. Dr. Crutchfield specializes in
skin-of-color and has been selected by physicians and nurses as one of the leading dermatologists in Minnesota for the past 18 years.
He is the team dermatologist for the Minnesota Twins, Vikings, Timberwolves, Wild and Lynx. Dr. Crutchfield is an active member of both the American and National Medical Associations and president of the Minnesota Association of Black Physicians. He can be reached at CrutchfieldDermatology.com or by calling 651-209-3600.