Car T-Cell Therapy

Virginia Oncology Associates is pleased to be the first cancer treatment center in Hampton Roads to offer chimeric antigen receptor (CAR) T-cell therapy, a promising new cancer treatment for patients with certain aggressive hematologic cancers who have exhausted standard treatment options. CAR T-cell therapy is a powerful new form of immunotherapy, a type of cancer treatment that uses the patient’s own immune system to fight cancer. While there have been many exciting developments over the last several years in immunotherapy, CAR T-cell therapy is moving to the forefront due to dramatic results from clinical trials for various blood cancers once considered incurable. In 2017, the FDA approved two CAR T-cell therapies treating adults with advanced lymphomas and children with acute lymphoblastic leukemia (ALL).

How CAR T-Cell Therapy Works

CAR T-cell therapy is a complex treatment that involves numerous steps over the course of several weeks.

• CAR T-cell therapy begins with a blood draw. A machine is used to separate out the T-cells, and the rest of the patient’s blood is pumped back into the body.
• The T-cells are sent to a special lab where they are injected with a disabled virus. The virus is used to insert new genetic information into the T-cells and can’t cause any harm. This instructs the T-cells to produce a new type of receptor on their surface called chimeric antigen receptors (CARs).
• These receptors are designed to seek out a specific protein, or antigen, found only on tumor cells. This ensures the T-cells won’t accidentally attack a healthy cell.
• Once the T-cell finds a tumor cell, the receptor attaches to the antigen and the T-cell releases toxic chemicals into the cancer cell to destroy it. The T-cell then alerts its “army” so that other T-cells flock to the area and begin fighting the rest of the cancer.
• After millions of these CAR T-cells are grown in a lab, the cells are safely sent back to the patient. This usually takes about two to four weeks, during which time the patient will be closely monitored.
• The new T-cells are then infused back into the patient’s blood. A short dose of chemotherapy may be administered before infusion. This weakens the existing immune system, giving the new T-cells a better chance at expanding and fighting the cancer.
• The T-cells begin to multiply once they are back in the patient’s blood, patrolling the body and destroying cancer cells when they are found.
• Patients will likely stay in the hospital for several days or weeks after infusion so side effects can be monitored. Side effects from this therapy can be severe and include high fevers, low blood pressure, seizures, severe headaches, low blood cell counts or a weakened immune system. Most side effects occur within the first 30 days, but in some cases can occur two to three months after treatment.

Cancers Currently Treated with CAR T-Cell Therapy

This exciting new treatment is in its infancy, and there are still many unknowns associated with it. While side effects can be significant, they are usually reversible. Additionally, the long-term toxicity of CAR T-cell therapy is unknown at this time. Currently, the treatment is approved by the FDA for use in patients with the following conditions after at least two other kinds of treatment have failed:

• Diffuse large B-cell lymphoma (DLBCL)
• Primary mediastinal large B-cell lymphoma
• High-grade B-cell lymphoma
• Follicular Lymphoma
• DLBCL arising from follicular lymphoma
• Mantle Cell Lymphoma
• Relapsed Lymphoma <12 months
• Relapsed B cell Acute Lymphoblastic Lymphoma
• Pediatric relapsed acute lymphoblastic leukemia

CAR T’s success with hematologic cancers has opened the door for its use in other cancer types. Cancer researchers across the globe have launched CAR T-cell clinical trials addressing various forms of lymphoma, mesothelioma and multiple myeloma, as well as lung, breast and ovarian cancers, exploring additional ways this powerful new immune booster can be used to fight cancer.

VOA's Team of Experts Are Specially Trained to Manage CAR T-Cell Therapy

Our practice is specially certified to offer CAR T-cell therapy, as this unique treatment is complex and there are risks associated with it. Virginia Oncology Associates is among only a handful of cancer centers across the U.S. with this certification, and the only center in our region certified to offer this advanced treatment. All of our staff involved in prescribing, dispensing or administering CAR T-cell therapy have received special training to recognize and manage treatment side effects and nervous system toxicities that may occur. Our multidisciplinary team of experts has extensive experience in managing treatment side effects, helping to ensure our patients have the best possible outcome and quality of life during and after treatment.

Listen to our podcast episode about CAR T-cell therapy.

On this episode of Cancer Care Connections, Dr. Gary Simmons discusses CAR T-cell therapy. Dr. Simmons is a hematologist oncologist and part of the transplant and cellular therapy team for Virginia Oncology Associates. Learn how CAR T-cell therapy is a revolutionary treatment for fighting blood cancer, and how continued research of this cellular therapy could change the landscape of cancer treatment.