For years, the foundations of cancer treatment were surgery, chemotherapy, and radiation therapy.
More recent drugs have centred on targeting the immune system to defeat the spread of cancer cells. The drug rituximab, for example, triggers the immune system to attack and kill cancer cells. Another targeted drug called ibrutinib blocks chemical messengers (enzymes) that stop cells growing and dividing in diseases such as mantle cell lymphoma and CLL (chronic lymphocytic leukaemia).
To understand what another of the latest cancer treatments does it helps to know a little about what T cells do.
T cells move around the body to find and destroy defective cells – they fight infections for instance, keeping some in reserve in case you come across that infection again.
Scientists have been working hard to find ways to get T cells to recognise cancer cells. One way they hope will succeed is CAR-T cell therapy.
It entails taking a sample of T cells from a patient. Then, in the lab the T cells are genetically engineered and returned to the patient where they recognise and target a specific protein on the cancer cells.
The NHS is playing a role in the introduction of CAR-T cell therapy; it announced in September 2018 a premier European deal that will allow children and young people to receive CAR-T therapy cancer treatment.
Regarded as a landmark arrangement with US company Novartis, it provides an opportunity for this revolutionary class of cancer treatments to meet the individual conditions of the patients involved.
Many of the earliest CAR-T therapy projects have tended to focus on patients who have relapsed conditions or previously undergone treatments that failed. As an advanced form of treatment it now requires evidence of effectiveness before achieving widespread acceptance.
As it is new and innovative scientists are still assessing how CAR-T cell therapy works; effectively how it triggers the immune system. One drug, for instance, may produce different signalling responses to an alternative drug; reflecting to some extent everyone’s unique biological characteristics and responses to therapy.
In a round table discussion in May 2018 between leading US experts a balance was struck between satisfaction at favourable treatment results so far and the many remaining questions still to be answered.
Access to a summary of these round table discussions can be found here: http://www.ascopost.com/issues/may-25-2018/weighing-the-cost-and-value-of-car-t-cell-therapy/
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