Until the 1990s, modern cancer care consisted of three pillars of treatment: surgery, radiation and chemotherapy. These pillars take a direct approach, removing or destroying cancerous tumors. In the last few decades, immunotherapy has emerged as another pillar of cancer care. This evolving treatment option takes an indirect treatment approach by equipping the body’s immune system to fight cancer.
“Immunotherapy has been around for quite some time and has really benefited a lot of patients, especially those with solid tumor cancers,” said Saurabh Dahiya, MD, FACP, hematologist, oncologist, assistant professor of medicine at University of Maryland School of Medicine and Director of Cellular Immunotherapy and Leukemia and Lymphoma at the University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center (UM GCCC).
Immunotherapy, which is often used alongside traditional therapies, has provided another avenue of treatment for certain types of cancer, including lung, kidney, liver, skin and bladder. Immunotherapy drugs, which boost the patient’s immune system response to cancer, are delivered through an IV over a prescribed number of treatments or through oral medication, depending on cancer type and patient need. Standard immunotherapy is provided to patients at University of Maryland Medical System cancer centers.
The Present Use and Promise of CAR T-Cell Immunotherapy
As the field of immunotherapy has progressed, one rapidly emerging subset of it—a cell-based, single-dose immunotherapy called chimeric antigen receptor T-cell, or CAR T—has allowed for another treatment of late-stage and recurring leukemia, lymphoma and multiple myeloma.
With CAR T-immunotherapy, specialists remove T-cells from patients during a three- to four-hour procedure in which a patient’s plasma is separated from blood cells. Then, a gene editing process retrains the T-cells to fight cancer, modifying them into CAR T-cells. This process takes place in an offsite lab over three to four weeks. Next, the CAR T-cells are IV-infused back into the patient, who is monitored in the hospital for side effects for one to two weeks and then for several months as an outpatient.
“The super-charged CAR T-cells have molecules on their surfaces that attract lymphoma, myeloma and leukemia cells and then eliminate them,” Dr. Dahiya said. “This is also a living treatment, which means once administered, the cells replicate, providing the patient with additional protection against cancer recurrence.”
UM GCCC is one of the few facilities in the country offering CAR T-cell treatment for lymphoma, multiple myeloma and leukemia patients who have exhausted all other treatment options. Innovations like this are why the center serves as the hub for the University of Maryland Cancer Network, which allows patients who receive care at their local hospital to access UM GCCC’s nationally renowned experts, technologies and other valuable resources.
The center, which draws patients from across the region, provided CAR-T cell care for its 100th patient in June 2020—a milestone that few other facilities in the U.S. have accomplished. What’s more impressive are the results of those treatments, producing responses in about 85% to 90% of patients.
“Gene editing of immune response cells to fight cancer is just beginning,” Dr. Dahiya said. “We’re in very early days of it and seeing promising results with patients. Nothing like it before has worked so well.”
The future of CAR T-cells looks bright, as well, with ongoing clinical trials for treating solid tumor and blood cancers as a first- or second-line therapy. The experienced team at UM GCCC is leading some of those clinical trials nationally and participating internationally, staying involved on all fronts in understanding more about unmet needs in cellular immunotherapy.
