by Dwain Hebda
The fight against cancer took another leap forward in Little Rock as the University of Arkansas for Medical Sciences (UAMS) announced a new treatment technology. Hospital officials made the announcement Sept. 20.
The new treatment, chimeric antigen receptor (CAR) T cell therapy, uses a patient’s own genetically modified T cells to fight cancer from within. T cells are a type of white blood cell integral to the immune system and through CAR T-cell therapy, cells are supercharged to seek and destroy cancer cells.
“CAR T-cell therapy is different than either stem cell transplants or chemotherapy, which are the first line of defense against blood cancers,” says Dr. Appalanaidu Sasapu, assistant professor in the UAMS College of Medicine Division of Hematology Oncology who leads the new CAR T cell immunotherapy program.
“This new, innovative approach actually programs the immune system to attack cancer and offers patients with aggressive disease new hope.”
The therapy, called Yescarta, will be applied in cases of relapsed, aggressive non-Hodgkin lymphoma. The process extracts the patient’s T cells through a simple blood draw, then a special machine separates the blood into base cellular components.
The T cells are then genetically modified thanks to the introduction of CARs, which have the ability to detect and kill cancer cells. Once reintroduced into the patient’s bloodstream, the T cells have been shown to attack cancer within a week.
UAMS reported in clinical trials that Yescarta has been shown to help 51 percent of patients achieve complete remission. Notably, the treatment is reserved for those non-Hodgkin lymphoma patients who don’t respond to at least two other types of treatment.
“The treatment is approved for when the first two lines of therapy have failed,” Sasapu says. “So, ideally, when patients are diagnosed, they get chemotherapy called R-CHOP for six cycles. And almost 60 to 70 percent of people will be cured with that.”
“The 30 to 40 percent of people that relapse, or they never go into remission with that R-CHOP front line chemotherapy, those candidates ideally get a different kind of chemotherapy called salvage chemotherapy.”
Patients in this second stage who meet certain criteria may also receive a stem cell transplant as a companion treatment. Sasapu says has been shown effective in about half of the patients at this stage.
For those that didn’t respond, about 20 percent of total cases, the prognosis was generally grim. Sasapu did not hesitate to call Yescarta a last-chance treatment option.
“Those who did not respond to the second-line chemotherapy or who failed autologous stem cell transplant, they did not have any choices before this immunotherapy approval,” he says. “Their median survival was only six months.”
Yescarta puts UAMS firmly on the vanguard of cancer treatment, having only been approved by the FDA in 2017. UAMS is the first and only Arkansas hospital to provide the revolutionary new therapy and enters a select group of just 84 health care entities nationwide where Yescarta is available.
Sasapu says UAMS completed the intensive training and certification process at the end of August.
“This is a very, very specialized type of immunotherapy treatment,” Sasapu says. “We do need special equipment to collect T cells called apheresis machines and those are not available just anywhere.”
“We also had to go through several steps with the company that makes the CAR T cell immunotherapy therapy. There’s a large amount of training that is involved; we have to train all the nurses, nurse practitioners, doctors and other people who are involved in delivering the medical care to these patients.”
Like most cancer treatments, Yescarta carries side effects, some of them severe, and hospital officials underscore it is not effective for everyone. But Sasapu is equally explicit in pointing out the potential for the new technology, noting it has already spawned treatment protocols for use in treating other types of cancer. He predicts more to come in the near future.
“There was a different type of drug that was approved for a different type of cancer already with this same technology using CAR T cells to attack,” he says. “That medicine was approved for children and adults up to the age of 24. And there are several other cancers being explored with this technology.”
“There is great data in multiple myeloma, a type of B cell cancer. I anticipate approval for multiple myeloma [treatment option] in the next one- to two-year time frame. And there are other cancers that were looking into with the same technologies, even solid tumor cancers, you name it.”