Immune therapy — hottest trend in cancer treatment
Doctors reprogram patients’ cells turning them into assassins
SEATTLE — Ken Shefveland’s body was swollen with cancer, treatments failing until doctors removed some of his immune cells, engineered them into cancer assassins and unleashed them into his bloodstream.
Immune therapy is the hottest trend in cancer care and this is its next frontier — creating “living drugs” that grow inside the body into an army that seeks and destroys tumours.
Shefveland said “the cancer was justmeltingaway.”Amonthlaterdoctors at the Fred Hutchinson Cancer Research Center couldn’t find any signs of lymphoma in the Vancouver, Washington, man’s body.
“Today I find out I’m in full remission — how wonderful is that?” said Shefveland.
This experimental therapy marks an entirely new way to treat cancer — if scientists can make it work, safely. Early-stage studies are stirring hope as one-time infusions of supercharged immune cells help a remarkable number of patients with intractable leukemia or lymphoma.
“It shows the unbelievable power of your immune system,” said Dr. David Maloney, Fred Hutch’s medical director for cellular immunotherapy who treated Shefveland with a type called CAR-T cells.
“We’re talking, really, patients who have no other options, and we’re seeing tumours and leukemias disappear over weeks,” added immunotherapy scientific director Dr. Stanley Riddell. But, “there’s still lots to learn.”
T cells are key immune system soldiers. But cancer can be hard for them to spot, and can put the brakes on an immune attack. Today’s popular immunotherapy drugs called “checkpoint inhibitors” release one brake so nearby T cells can strike. The new cellular immunotherapy approach aims to be more potent: Give patients stronger T cells to begin with.
Currently available only in studies at major cancer centres, the first CAR-T cell therapies for a few blood cancers could hit the market later this year. The U.S. Food and Drug Administration is evaluating two different versions.
CAR-T therapy “feels very much like it’s ready for prime time” for advanced blood cancers, said Dr. Nick Haining of the Dana-Farber Cancer Institute and Broad Institute of MIT and Harvard, who isn’t involved in the development.
Now scientists are tackling a tougher next step, what Haining calls “the acid test”: Making T cells target far more common cancers — solid tumours like lung, breast or brain cancer. Cancer kills about 600,000 Americans a year, and approximately 79,000 in Canada.
Scientists still are unravelling why these living cancer drugs work for some people and not others.
Doctors must learn to manage potentially life-threatening side effects from an overstimulated immune system. Also concerning is a small number of deaths from brain swelling, an unexplained complication that forced another company, Juno Therapeutics, to halt development of one CAR-T in its pipeline; Kite recently reported a death, too.
At a recently opened Seattle immunotherapy clinic, scientists are taking newly designed T cells from the lab to the patient and back again to tease out what works best.
“We can essentially make a cell do things it wasn’t programmed to do naturally,” explained immunology chief Dr. Philip Greenberg. “Your imagination can run wild with how you can engineer cells to function better.” Two long weeks to brew a dose When leukemia patient Claude Bannick entered a Hutch CAR-T study in 2014, nurses hooked him to a machine that filtered out his white blood cells, including the T cells.
Technicians raced his bag of cells to a factory-like facility that’s kept so sterile they must pull on germdeflecting suits, booties and masks just to enter. Then came 14 days of wait and worry, as his cells were reprogrammed.
Bannick, 67, says he “was almost dead.” Chemotherapy, experimental drugs, even a bone-marrow transplant had failed, and “I was willing to try anything.” ASK AMY
At the beginning of the year, I hooked up with an amazing woman.
She is in her mid-40s — I am eight years her junior.
She is sweet, caring, gorgeous, sexy, strong, fun, intelligent — the whole package. However, after we hooked up, she turned things off pretty quickly. She said she’s sure that there is another person out there for me, but it isn’t her.
We are still friends and talk on a regular basis. Her family disowned her for reasons that I found to be petty and cruel, given how amazing she is.
I just have a hard time being around her lately. I don’t know if it’s just a desire to prove to her that I’m good for her, and that she is good enough for someone to love (she has problems with self-esteem and depression, like me). I wonder if I’m reacting to having someone easy to get along with after an eight-year hiatus from dating, or if my feelings for her are just lust over how good the sex was.
When she told me that people didn’t remember her birthday last week, I rushed out, bought flowers, a case of her favourite beer, and came over to her house and talked and laughed with her until midnight.
She’s commented on how big my heart is and how nice and kind I am, but I’m worried that the only reason I do these things is a secret desire to try to get into her pants again. I don’t want to lead her on under false pretences, but I can’t continue thinking that the only reason I’m doing this is a juvenile lusting. Help! — WORRIED FRIEND
Don’t diminish the power of juvenile lusting. All lusting, on some level, feels juvenile — and that’s a good thing. But, you may have to confront the idea that the sex was good for you, but maybe not for her.
You are obviously attempting to court this woman, and that’s also a good thing. The trick is to be honest about your intentions, and respectful of her hesitation. She has already stated that she doesn’t want to continue with a sexual relationship, and if that is her low self-esteem talking, your ongoing courtship and friendship might prove to her that you are an able and trustworthy partner.
Don’t make any sudden moves, and include and involve her by conveying your intentions. However, if she wants to keep you in the friend zone, it is important that you learn to take “no” as an answer. She is right — there is someone out there for you, and this experience should also give you the courage to get out there and keep trying.