CAR-T Cell Therapy: Personalized Cancer Treatment

Shreeti Amit | February 8th, 2024

For the last few years, cancer treatment has been a combination of surgical interventions, chemotherapy, and radiation therapy. Each of these procedures is a grueling process on the body and often has long-lasting negative side effects. Chemotherapy specifically leads to physical changes ranging from nausea and vomiting to more serious conditions such as peripheral neuropathy and fertility issues. Thus, supportive care measures are crucial in improving the quality of life of patients undergoing chemotherapy. The side effects of these cancer treatments underscore the need for ongoing research and development of targeted therapies to minimize such adverse effects. 

Immunotherapy

Immunotherapy has been a cutting-edge advancement in the field of medical oncology. This technique utilizes the patient’s immune system to strengthen it in order to internally fight tumors rather than attacking cancer cells externally through traditional treatments. One such immunotherapy that has been developed in recent years is Chimeric Antigen Receptor T-cell or CAR-T Therapy. Six types of CAR-T Therapies have been approved by the Food and Drug Administration (FDA) since 2017, including treatments for several types of lymphomas, leukemias, and myeloma.  

How It Works

First, T cells (a type of immune cell) are extracted from the patient’s blood through a process called leukapheresis. This involves separating the blood components, isolating the T cells, and returning the remaining blood to the patient. These T cells are genetically modified to express a chimeric antigen receptor (CAR) designed to recognize a specific antigen in cancer cells. This CAR is a fusion protein that combines the antigen-recognition region of an antibody with signaling components from T cells. The CAR is designed to target a specific antigen on the surface of cancer cells. The new genetically modified T cells expressing CAR are cultured and expanded to large numbers. For the next step, the patient must undergo a conditioning treatment. This typically involves a short course of chemotherapy which ensures that the patient’s body won’t reject the new cells, making room for the newly infused CAR-T cells to proliferate and function effectively. The CAR-T cells are infused back into the patient’s bloodstream and circulate throughout the body, seeking and recognizing cancer cells that express the targeted antigen. The CAR on the surface of the T cells allows them to recognize and bind to the specific antigen on cancer cells. This binding triggers the activation of the T cells, leading to the release of cytotoxic substances and the initiation of an immune response against the cancer cells. The activated CAR-T cells multiply and persist in the body, providing an ongoing and targeted attack against the cancer. Lastly, patients are closely monitored for potential side effects and to assess the treatment’s effectiveness.

Continued Work 

The research surrounding this treatment is young but extremely promising. A recent 2020 study followed children with acute lymphoblastic leukemia (ALL) and found that more than 85% of the children had complete remission and 60% of these children were cancer-free for 12 months after the treatment. Currently, Monroe Carell Jr. Children’s Hospital at Vanderbilt is the only approved facility in the state of Tennessee that offers CAR-T Therapy for pediatric ALL patients. Vanderbilt is also currently participating in clinical trials for the treatment among relapsed and refractory patients of ALL. The Vanderbilt-Ingram Cancer Center is the only facility in “a seven-state area in the Southeast” that offers this type of immunotherapy treatment to patients who meet certain criteria. VUMC laboratories are continually involved in ongoing research that aims to broaden CAR-T Cell Therapy’s applicability to different cancer types and enhance its overall effectiveness.

Works Cited

1. “CAR T Cells: Engineering Patients’ Immune Cells to Treat Their Cancers.” National Cancer Institute, 10 Mar. 2022, www.cancer.gov/about-cancer/treatment/research/car-t-cells.
2. “Car T-Cell Therapy.” Malaghan, www.malaghan.org.nz/our-research/car-t-cell/. Accessed 22 Nov. 2023.
3. “Car T-Cell Therapy: Procedure, Prognosis & Side Effects.” Cleveland Clinic, 19 Jan. 2022, https://my.clevelandclinic.org/health/treatments/17726-car-t-cell-therapy.
4. “Car T Cell Therapy.” Vanderbilt Children’s Hospital Nashville, TN, Monroe Carell Jr. Children’s Hospital at Vanderbilt, 15 Apr. 2021, www.childrenshospitalvanderbilt.org/treatment/car-t-cell-therapy. 
5. “Chemotherapy Side Effects.” American Cancer Society, 1 May 2020, www.cancer.org/cancer/managing-cancer/treatment-types/chemotherapy/chemotherapy-side-effects.html. 
6. “Chimeric Antigen Receptor T Cell (CAR T) Therapy.” Vanderbilt Health Nashville, TN, Vanderbilt Health, 23 May 2023, www.vanderbilthealth.com/treatment/chimeric-antigen-receptor-t-cell-car-t-therapy.