Benefit in focus: CAR-T cell therapy – the newest therapy for cancer

How cell therapies that harness and enhance a patient’s own biology are now treating people.

The immune system relies on T-cells to fight off viruses and bacteria. These lymphocyte white blood cells tackle all but the most virulent invaders. But cancer cells are, from the immune system’s perspective, part of the body which means that T-cells sometimes don’t recognise them as defective. In November 2018 an NHS England patient was treated with chimeric antigen receptor therapy [CAR-T]. This is a new treatment in which a patient’s T-cells are re-engineered.

The moment marked the culmination of decades of research. Kite Pharma and Oxford Biomedica are two of the many companies working on this type of cancer treatment. A personalised process, CAR-T therapy reprograms the T-cells to identify certain cancer cells directly.

How does the treatment work?

First, a patient’s white blood cells are removed and transported to a specialised laboratory. The T-cells are then separated out and grown in the lab. At that point a new gene is introduced, adding the CAR, that can recognise and target cancer cells. The re-engineered cells are then multiplied, ready to be infused back into the patient. As CAR-T is an individualised treatment, traceability is paramount.

What types of cancer will CAR-T cell therapy treat?

Having been approved by NICE (National Institute for Clinical Excellence) for some types of blood cancer, CAR-T cell therapy is now up and running in the NHS and the private sector, for the benefit of employees with private medical insurance.

This type of therapy is suitable only in certain circumstances. Children and young people under the age of 25 with B cell acute lymphoblastic leukaemia and adults with certain types of B cell lymphoma may be recommended for it. In the case of young patients with the correct type of leukaemia, it may be used in some cases where the disease has come back, having not responded to other types of treatment. Similarly, for adult lymphoma patients, it may be used when other treatment doesn’t seem to have worked.

IHC consultant, Paul Roberts, explains: “CAR-T is certainly a very exciting development in cancer treatment, coming after 30 years’ of research into immunotherapy. But it should be stressed it’s only used to treat blood cancers and only works for some patients. Solid cancers are more difficult to target in this way and the quest for learning continues. But for employees who fall into the group of people who may benefit from this innovative new treatment, it’s a breakthrough indeed.”

Where will the treatment be available?

CAR-T cell therapy will only be used in very limited cases and will not be available everywhere. For young people, there are nine places in the UK which offer CAR-T cell therapy, including Great Ormond Street Hospital in London and the Manchester Royal Infirmary, while for adults with the relevant large B cell lymphomas it is available in centres in London, Manchester, Bristol, Birmingham and Newcastle. Patients living in Wales and Northern Ireland will be able to travel to England to have it, while under-25s with B-Cell acute lymphoblastic leukaemia from Scotland may also be able to access it over the English border.

Are there any side effects?

Harnessing the body’s own immune response inevitably carries risks that can activate an inflammatory response. Patients need to be aware that this intensive therapy can make them sicker and side effects can be great.

How can employees access CAR-T cell therapy?

NICE (The National Institute for Clinical Excellence) has approved the use of CAR-T cell therapy in England in the cases outlined above. It is now being covered as part of private medical insurance policies. To find out more about this treatment and how employees can access it, talk to your IHC consultant.