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When standard treatment is no longer effective, patients with certain types of lymphoma, leukemia and myeloma may turn to immunotherapies — groundbreaking treatments that train the immune system to eliminate cancer cells. Parameswaran Hari, MD, explains chimeric antigen receptor (CAR) T-cell therapy and other cellular therapies on the horizon.

What is CAR T-cell therapy?

T cells from the immune system are extracted from the patient’s blood. These cells are re-engineered in a lab to express chimeric antigen receptors — structures that recognize proteins on the surface of cancer cells. CAR T cells are then returned to the patient’s body to find and destroy cancer cells.

Why is CAR T-cell therapy a significant advance?

It’s the first cancer treatment made of cells and the first in a wave of developing cellular therapies. CAR T-cell therapy can provide long-lasting immunity against certain types of cancer, and remission rates are good. When successful, patients typically don’t need follow-up therapies like maintenance chemotherapy.

What’s next for CAR T and other cellular therapies?

Now, CAR T is an option when standard therapies are exhausted. We want to be able to offer it earlier in treatment — and we want to target other cancers with CAR T so more people can benefit. The FDA will likely approve it for myeloma soon. Other cellular therapies being studied through the Cancer Network include: • T-cell receptor therapy (TCR), which uses T cells to target specific proteins inside a cancer cell • Natural killer cells (NK cells), donor lymphocytes that find and eliminate abnormal cells • Autologous tumor-infiltrating lymphocytes (TILs), which are cultured in a lab with lymphokines and then infused into the patient to remove certain tumor cells

Can we treat solid tumors like breast, colon and lung tumors with CAR T-cell therapy?

Right now, it’s challenging because proteins on the surface of solid tumors are shared by normal tissue, which we don’t want to disturb.

Describe the Cancer Network’s commitment to immunotherapy research and focus for the future.

Renowned for our research in blood and marrow transplant and immunotherapy, we are exploring a CAR T-cell approach that targets two antigens on a cancer cell. This research has paved the way for a national clinical trial.

We are also one of few centers in the world with an on-site cell-processing lab, making the cells available faster to patients than if we sent them to an outside lab. We are studying ways to make CAR T-cell therapy more potent and safer and to understand its side effects, as well as which patients benefit most and why. We are researching new targets so patients we can’t treat today with CAR T cells can benefit in the future. We are also developing new forms of cellular therapies.

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