Updates in Targeted Therapies for B-Cell Malignancies - Episode 15

B-Cell Lymphomas: Practical Advice on CAR T-Cell Therapy


Stephen J. Schuster, MD: The really important message from the presentations at this meeting is that immunotherapy is now a cornerstone of oncology. We have always had surgery and then radiation therapy and chemotherapy as the 3-legged stool that oncologic therapeutics sat on.

Now there’s another leg: immunotherapy. It’s cellular immunotherapy, or using the cells of the immune system—either T cells or natural killer cells—to treat cancer. We’re recognizing that it’s a pillar of oncologic therapy going forward, particularly in lymphoid malignancies. I think it will soon be applicable in other fields, and it becomes important for the practicing oncologist to preserve the immune system.

Unfortunately, many of the chemotherapies that are used to treat lymphoid malignancies, lymphomas, and leukemias kill normal immune system cells—normal T-cells and normal lymphocytes, sometimes even more effectively—as well as malignant cells. Then if a patient has been through a lot of these treatments and they come to us for cellular immunotherapy, we can’t get the cells from the patients that we need to make a therapeutic agent for them.

There are active investigations around that, with people are developing off-the-shelf CAR [chimeric antigen receptors] T cells. They don’t have to be derived from the patient but can be from a universal donor or an engineered T cell. In a lot of the sessions I went to, even the ones that were outside the meeting with some of the companies and scientists, this was an active area of discussion and a big thrust in development.

We already have 1 FDA-approved CAR T-cellular immunotherapy for pediatric and young adult acute lymphocytic leukemia [ALL], as well as diffuse large B-cell lymphoma. Keep in mind that these are derived from the patients’ own T cells, and for that reason, we need to preserve the immune system. If somebody fails primary therapy, it’s probably time to hook them up with a center that’s involved in doing this before you go on to the next therapy. If they need to harvest T cells, they can partner with the practicing oncologist to work out the best strategies for next therapies, preserving the immune system, and scheduling collection of T cells.

I think that particularly with these lymphoid malignancies, the practicing oncologists need to be quite familiar with their regional centers that offer this form of therapy and bring patients to the attention of those centers early when primary therapies are not working.

Transcript Edited for Clarity