CAR T-cell therapy is a groundbreaking immunotherapy treatment that was developed by work led at Penn Medicine in Philadelphia and is now available in Lancaster from the team at the Ann B. Barshinger Cancer Institute. We’re answering the questions that many patients and families are asking.
What is CAR T-cell therapy and how does it work?
CAR T (Chimeric Antigen Receptor T-Cell Therapy) is an advanced cancer treatment that genetically reprograms a patient’s own T cells—a type of white blood cell that fights illness and infection—to better target and destroy cancer cells.
The CAR T-cell therapy process starts by collecting blood from a patient with cancer. T cells are extracted from the blood—a process known as leukapheresis, which is similar to the process of dialysis. The T cells are taken to a lab where they are reprogrammed with new receptors (CAR) that recognize and attack cancer cells.
The patient’s reprogrammed T cells are returned frozen from the lab. They are warmed and immediately reinfused, just as a person receives a blood transfusion. Once CAR T cells are infused into the body they immediately search for, attach to, and destroy cancer cells in every part of the body.
Is CAR T-cell therapy stem-cell therapy? Is it gene therapy?
CAR T is not stem-cell therapy, but is considered a form of gene therapy as well as a form of immunotherapy.
What cancers can be treated with CAR T-cell therapy?
CAR T-cell therapy has already been proven to work very well for blood cancers. Penn Medicine Lancaster General Health offers CAR T for diffuse large B-cell lymphoma. Penn Medicine in Philadelphia can treat all lymphomas, myeloma, and leukemia, and is conducting clinical trials for solid tumors including glioblastoma.
What is the success rate of CAR T-cell therapy?
In studies, 9 out of 10 people with acute lymphoblastic leukemia whose cancer didn't respond to other treatments or whose cancer came back had full remission with CAR T-cell therapy. Remission means the cancer can't be detected in tests.
Complete remission rates for chronic lymphocytic leukemia and non-Hodgkin lymphoma are 35–70%. Of that number, about a third have long-lasting remissions.
Some patients can be cured. For a significant number of patients, remission will be long-term. However, for others, remissions may not be permanent.
What are the risks and side effects?
Patients treated with CAR T-cell therapy don’t experience the hair loss typically associated with chemotherapy. They are, however, at risk for a severe (but short-term and manageable) side effect called cytokine release syndrome (CRS).
Cytokines are proteins that immune cells release when they attack an infection. CRS causes a high fever and severe, flu-like symptoms which may include nausea, chills, headache, rash, fatigue, low blood pressure, body aches, a racing heart and difficulty breathing.
The term “cytokine storm” became more widely used during the COVID-19 pandemic, as some patients experienced a similar excessive immune response. For CAR T patients, fever is considered a good sign that the therapy is killing tumor cells. CRS can be serious, but manageable in a hospital. A drug called tocilizumab can entirely reverse CRS fairly quickly.
Additional potential side effects in some people may include neurologic symptoms such as confusion, trouble speaking, tremors or seizures.
These short-term effects are generally fully reversible. Long-term effects of CAR T-cell therapy may not be fully known since the therapy has been available for only one decade. But we do have 10 years’ experience and have not had any unexpected long-term complications. We continue to observe carefully and will report openly any new findings of concern.
Is CAR T-cell therapy FDA approved?
The FDA approved the first CAR T-cell therapy in 2017. Currently, six CAR T-cell therapies are FDA-approved for treating cancer, including:
- Axicabtagene ciloleucel (Yescarta)
- Tisagenlecleucel (Kymriah)
How long do CAR T cells persist?
CAR T-cell therapy is a “living drug” and intended to remain in the body fighting cancer. For most people, CAR T is a one-time treatment and the T cells remain in the body for months and years. For some, the T cells go away quickly. In patients who have lost the cells quickly, the treatment can be repeated safely. Determining the factors that contribute to the duration of CAR T cells is an area of continued research at Penn Medicine.
How long does it take to recover from CAR T-cell therapy?
Patients may be hospitalized for up to two weeks following infusion and should expect a risk/recovery period lasting approximately two to three months. During this time, patients are evaluated for side effects and treatment response. It is not unusual for patients to be admitted to the hospital during this period to manage complications. Patients must remain close to the medical facility for regular follow-up care for the first 30 days after CAR T-cell infusion.
How do I know if I am eligible for CAR T-cell therapy or if my loved one is eligible?
If you or a loved one has aggressive lymphoma that has not responded to one or more therapies, consider asking your hematologist oncologist (a doctor who specializes in treating cancers of the blood) about CAR T-cell therapy. Doctors at the Ann B. Barshinger Cancer Institute will help you understand how to best treat your disease and if CAR T may be an option here in Lancaster or at Penn Medicine in Philadelphia.
Will my insurance cover CAR T-cell therapy?
CAR T-cell therapy is a newer type of treatment and insurance coverage varies. If you are a recommended candidate, we will work with you and your health insurance company to determine if treatment will be covered. This includes any appeals process with the insurance company.