Connections is a quarterly newsletter for primary care providers covering the latest developments and advances in medicine at OHSU. Learn about the many clinical, education and outreach resources available to you and your patients.
From the OHSU Knight Cancer Institute
Brandon Hayes-Lattin, M.D.
Dr. Brandon Hayes-Lattin’s clinical background is in the management of hematologic malignancies and the use of hematopoietic stem cell transplantation.
When the Food and Drug Administration approved the first use of chimeric antigen receptor T-cell (CAR-T) immunotherapy in 2017, the agency hailed it as a historic action, marking the first gene therapy available in the U.S. Initially, CAR-T immunotherapy was approved as a treatment for relapsed, refractory lymphoma in adults. In 2018, approval expanded to acute lymphoblastic leukemia and lymphoma in children and adults. In 2018, approval expanded to acute lymphoblastic leukemia and lymphoma in children and adults.
Our experience has been very exciting, producing manageable toxicities and remarkable responses in cancers that didn’t have any good standard chemotherapy options. This is a major step toward finding the holy grail of cancer immunotherapy: an immune attack that successfully kills cancer cells without damaging healthy cells.
CAR-T immunotherapy process
CAR-T immunotherapy uses patients’ own T-cells to attack cancerous B-cells. In this therapy, we extract patients’ cells and reengineer them to specifically target the CD19 marker on those B-cells. Then we reinfuse the patients with their adapted cells. After this single infusion, we require patients to stay within two hours of OHSU for the first four weeks. Then we can maintain follow-up at a distance, if necessary.
This targeted method is exciting because it could replace other immunotherapies, such as checkpoint inhibitors or allogeneic bone marrow transplants, that nonspecifically turn on the immune system. Unlike bone marrow transplant, it does not require an immune match. Currently, there are two FDA-approved CAR-T therapy commercial products for use in patients with adult B-cell non-Hodgkin’s lymphoma who have failed two standard treatments. There is one FDA-approved CAR-T therapy for children and young adult patients with acute lymphoblastic leukemia who have failed one line of standard treatment.
OHSU participated in the phase 2 clinical trials that led to FDA-approval for this treatment. OHSU and Doernbecher Children’s Hospital are among only a handful of centers in the nation trained and certified to provide this therapy.
More wide-ranging trials in 2019 and beyond
Though we can only treat a limited set of cancers with CAR-T immunotherapy now, prospects are very promising that we will expand this therapy in the next several years. The next set of trials will likely expand into other hematologic cancers, such as chronic lymphocytic leukemia and multiple myeloma. Also, we anticipate new trials of CAR-T therapy in first line or second line treatment for adult lymphoma and childhood acute lymphoblastic leukemia. If you have patients with aggressive lymphoma or other hematologic cancers that aren’t yet FDA-approved for this therapy, we would be happy to explore if there is an appropriate trial coming available soon and if your patient could be eligible.
Potential steps forward in cancer treatment
This innovative therapy will help advance personalized immunotherapy treatment for patients, with many patients achieving sustained remission of their leukemia through this novel therapy. It will be exciting to bring these treatment options in earlier and earlier. This will fend off some of the detrimental effects on the body caused by these diseases and the repeated cycles of chemotherapy currently used to treat them. In current practice, because of repeated cycles of chemotherapy, the primary care of patients often shifts to the oncologist's office. We can envision a day where cancer treatment with CAR-T is managed as a procedure, like a surgery — the primary care provider refers the patient for one treatment and the patient then returns to their care for follow-up. We are in the early days of this immunotherapy and there is still a learning curve, but it is a source of hope for the future of cancer treatment.
If you have questions about CAR-T immunotherapy, we are happy to discuss the treatment and discuss eligibility of patients for this therapy or upcoming trials.
If you have questions or would like to refer a patient for evaluation, please call the OHSU Physician Advice and Referral Service at 503-494-4567.
New Knight Cancer Research Building open
In September 2018, OHSU opened a state-of-the-art research facility aimed at cutting-edge approaches and early detection for cancer. Located at the South Waterfront campus, the 320,000-square-foot building will bring together 650 employees, including researchers from different scientific disciplines, under one roof. The building will house the Cancer Early Detection Advanced Research Center, or CEDAR, led by nanotechnology expert Sadik Esener. Researchers will also investigate computational biology, population health, precision medicine and related fields. The purpose of this facility is to be a resource for Oregonians and people across the country as we strive to defeat cancer.