An innovative cancer treatment that uses a patient’s own immune system to attack the disease is now available for patients in Vermont and northern New York for the first time.
CAR T-cell therapy was approved in 2017 for a variety of blood cancers, and has led to encouraging results for patients.
Dr. James Gerson was among the first physicians in the country to use the treatment in a clinical setting, at the University of Pennsylvania.
He’s now at the University of Vermont Cancer Center, which just began its own CAR T-cell therapy program. And he joined Vermont Public’s Mary Williams Engisch to talk about the treatment. Their conversation below has been edited and condensed for clarity.
Mary Williams Engisch: First, can you provide more background on CAR T-cell therapy? How does it differ from other cancer treatments?
Dr. James Gerson: This therapy really is one of the most innovative and advanced treatments that's ever come to certainly oncology — and likely medicine at large. In contrast to most therapies that people are generally familiar with, where a medication is manufactured in large scale and patient will be in need of it so it's taken off of the pharmacy shelf or given intravenously — this is a personalized living therapy that's administered to patients with a variety of cancers.
And so it involves taking out the patient's immune cells, which we call the T-cells and engineering them to target a variety of cancers, and then administering them back into the patient almost like a blood transfusion. After which they hunt down, and in best case scenario, destroy the cancer killing it off entirely.
I know it's still relatively early in the history of this treatment, but what kind of results are we seeing in patients overall?
The patients who are eligible for this treatment are patients who unfortunately have been treated with almost everything that's available to them, patients with advanced cancer, who've been treated with all the [Federal Drug Administration] approved treatments — but nothing's really worked, or their cancer has come back despite these therapies. And so these patients really can do remarkably well with this therapy. And in many cases, patients go into a complete remission; the cancer disappears on all of our best imaging modalities. The first patient to receive this therapy is still in remission 10 years later. So we can't promise a cure, but it's most likely that it is cured if it hasn't come back in that timeframe.
It certainly doesn't work for everybody. And we're trying our hardest to figure out why that is and how to help more patients, but a majority are seeing some benefit, and many are seeing a complete remission or potential cure.
Dr. Gerson, what what kind of role did you have in developing and testing CAR T-cell therapy?
I was part of the University of Pennsylvania team when these therapies were first FDA-approved and came from the research lab into the clinic on a commercial setting, and was able to start treating patients right when this therapy became available.
And I came to University of Vermont because I was given the opportunity to start a program to offer this therapy to a population that otherwise wouldn't be able to receive it unless they traveled quite a distance. So there are other centers in the region that this therapy is offered at. But you know, somewhere between a two- and four-hour drive. And because of the nature of this therapy — it's given over multiple encounters for months on end — for a patient to receive it in another center, they essentially have to pick up their life and move to that site. Having the opportunity to come here and be able to start a program and offer it to people so that they didn't have to upend their life was really such a unique one that I jumped at the opportunity and came up here.
What was that first moment using the therapy like for you, as a physician watching your patients?
I'll tell you, in many ways, it felt like the wild west. We'd had experience with this therapy on a research setting. But you know, really no idea how best to give it, how best to prevent some of the side effects. We were learning as we treated patients, to be completely honest with you. And it was a little scary at times, but also really rewarding because we've learned so much and we've come so far from then.
Five years later, we have so much better treatments for the side effects, ways to prevent the side effects. We know a lot more about how to administer the therapy, what the right timing should be, how to prepare patients so that they can have the best chance of a response. Going from, again, what felt like the wild wild west to something that, to be honest, is very routine now. It's much easier now than than it used to be when we really, in many ways, had not a lot of idea what we were doing.
And you had mentioned before — this treatment, available at UVM Cancer Center, where previously patients in Vermont and in upstate New York had to travel quite far. What does that mean in terms of time saved and miles not driven and money saved for local cancer patients?
You know, one of the biggest challenges with having patients travel for this therapy is not only the cost that they may have from a copay perspective or out-of-pocket costs for medical care, which, you know, that's going to be the same everywhere — but really the costs that are unforeseen about paying for a hotel, paying for lodging, paying for food, paying for all the things that when you're traveling for months on end you have to grapple with. And so being able to save patients not only the time of driving, but also those unforeseen costs in terms of living expenses so they can stay close to home really is going to be such an important thing for the individuals who received this therapy.
The other cost, of course, is to the family member who is accompanying them. This therapy really requires that a caregiver be present essentially 24 hours a day. And so to think about not only the patient up and moving to another city, but bringing a loved one with them — then it's sort of double the impact. And so to allow their family member who's accompanying them through this journey to stay local as well, that's obviously going to have doubled the implication.
What's next for CAR T-cell therapy? I understand it's still rapidly evolving.
Yeah, this therapy is really evolving a mile a minute. And right now it's only available for patients with blood cancers, and blood cancers are relatively uncommon when you compare it to something like breast cancer or prostate cancer or colon cancer.
Really, we hope that through a variety of different research projects that we can expand this into other cancer types to really increase our impact so that we're helping even more patients.
The other area that we're actively researching is how we can make this safer, we can make it work better. I think I had mentioned that it doesn't work for everybody. So how can we improve these therapies so that they can treat more patients and help more patients? Because our dream is to cure everyone we meet, and right now we can't offer that. But that's what we're we're working towards.
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