Cancer has traditionally been treated with surgery, harsh chemotherapy and radiation. The emergence of targeted biologic therapies has set a new standard for treatment in terms of safety and efficacy; however, much more could be done in the battle against cancer. Immunotherapy with chimeric antigen receptor T-cells (CAR-T cells) could be the next revolution in cancer treatment.
Immunotherapy is personalized and uses the patient’s own immune system to recognize and destroy cancer cells. In CAR-T cell therapy, T-cells are collected from the patient’s blood and genetically engineered to express CAR proteins which help T-cells specifically bind a target antigen (e.g. CD19 or CD20) on the surface of cancer cells. The engineered T-cell population is expanded in a laboratory then infused back into the patient where the cells use the body’s natural systems to multiply, identify and attack cancer cells.
CAR-T cell therapy has shown promising results in B-cell acute lymphoblastic leukemia (B-ALL), B-cell non-Hodgkin’s lymphoma, chronic lymphocytic leukemia and Hodgkin’s lymphoma with complete remission rates of up to 94%. However, there are challenges that need to be overcome before CAR-T cell therapy can shift the cancer treatment paradigm, including antigen loss relapse, on-target/off-tumour toxicity, less efficacy in solid tumours and difficulty of industrialization. Despite these limitations, companies including Novartis, Juno and Kite Pharma are developing CAR-T cell therapies and we could see the first FDA-approved CAR-T cell therapy by the end of this year.