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CAR T-cell therapy

Markey now offering life-saving CAR T-cell therapy

The UK Markey Cancer Center is the first hospital in Kentucky approved to offer Yescarta®, the first FDA-approved CAR T-cell therapy for adults with diffuse large B-cell lymphoma, the most common type of non-Hodgkin lymphoma.

CAR T-cell therapy is a type of immunotherapy where the patient’s own immune system is used to fight back against cancerous cells. At Markey, this therapy will be used specifically for patients whose cancer has not responded to standard treatment, including chemotherapy and bone marrow transplantation.

“CAR T-cell therapy is one of the most powerful and promising immunotherapies available, and we are thrilled to be able to offer this life-saving treatment here in Kentucky,” said Dr. Mark Evers, director of the UK Markey Cancer Center. “As the only National Cancer Institute-designated cancer center in the state, it’s our responsibility to bring innovative therapies like this to our patients, allowing them to receive the latest, greatest cancer care without having to cross state lines.”

How it works

T-cells are a type of white blood cell used by the immune system to fight off infection and disease. During CAR T-therapy, T-cells are taken from a patient’s blood and modified in the laboratory. During this process, a receptor called chimeric antigen receptor (CAR) is placed in the outside wall of the T-cells.

When modified T-cells are infused back into the patient, these cells lock onto cancer cells using a “key – keyhole” approach, where their new receptor binds to a specific structure on the cancer cells. This allows the T-cells to kill cancer cells in a very targeted way.

“CAR T-cell therapy is very promising – you can really bring about a complete remission in patients who have failed several other lines of treatment.” - Dr. Gerhard Hildebrandt

“Unlike allogenic bone marrow transplantation, where you use cells from the immune system of another person to fight the cancer and run the risk of the donor immune system attacking the patient’s organs, CAR T-cell therapy uses the patient’s own cells,” said Dr. Gerhard Hildebrandt, division chief of Hematology and Blood and Marrow Transplantation at UK. “Essentially, we’re taking the patient’s immune cells and equipping them with the tools to fight back against their own cancer.”

Rescue therapy

The new therapy offers hope for those who have failed the standard of care for diffuse large B-cell lymphoma and would have otherwise only very limited options. The results for Yescarta are impressive for these patients: 54 percent achieved remission and 52 percent were alive at 18 months, based on the ZUMA-1 trial published in the New England Journal of Medicine last year.

Although the treatment is effective, it does come with the possibility of side effects. The most significant side effect is cytokine release syndrome, a general inflammatory response in the body and toxicity to the brain. Most cases are mild, but occasionally these reactions can be life-threatening. Therefore, patients receiving CAR T-cell therapy will be carefully screened prior to and monitored closely following their treatment.

Hildebrandt notes that the therapy isn’t currently approved as a first-line option for treatment, but rather a “rescue” when the standard of care has failed the patient. However, he states that this powerful new immunotherapy is currently being studied for earlier use in this disease and other cancers.

“CAR T-cell therapy is very promising – you can really bring about a complete remission in patients who have failed several other lines of treatment,” Hildebrandt said. “It’s a very big step in treating cancer in the future, and it will probably change how we treat our cancers across different fields within the next few years.”

Yescarta is the first CAR T-cell therapy Markey will be offering. Several other immunotherapies targeted at various blood cancers are in the pipeline for the cancer center.

CAR T-cell therapy
CAR T-cell therapy is a type of treatment in which a patient ‘s T-cells are genetically engineered in the laboratory so they will bind to specific proteins (antigens) on cancer cells and kill them. (1) T-cells are removed from the patient’s blood. Then, (2) the gene for a special receptor called a chimeric antigen receptor (CAR) is inserted into the T-cells in the laboratory. The gene encodes the engineered CAR protein that is expressed on the surface of the patient’s T-cells, creating a CAR T-cell. (3) Millions of CAR T-cells are grown in the laboratory. (4) They are then given to the patient by intravenous infusion. (5) The CAR T-cells bind to antigens on the cancer cells and kill them.

New UK policy gives medical leave to bone and organ donors

To give generous bone and organ donors more peace of mind, UK enacted a new leave policy for full-time employees: Employees will receive five days paid medical leave for donating bone marrow or 30 days for donating a solid organ (kidney, partial liver or partial lung).

At the Markey Cancer Center, physicians perform around 110 bone marrow transplants each year. For patients dealing with blood cancers, receiving bone marrow may be their only option for survival. A bone marrow donor can expect to take from one to seven days until they feel normal again.

“Implementation of this medical leave policy is a fantastic step in the right direction, as it will help UK donors to fulfill their goal, which is to help and possibly provide the only chance for a cure to our patients and to patients around the globe,” said Dr. Gerhard Hildebrandt, division chief for Hematology and Blood and Marrow Transplantation.

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