Cancer care will never be the same again

Breakthroughs in immunotherapy have let us fight back against the most deadly of diseases

There are times when we can recognise, as Winston Churchill said after a key Allied victory, that what has just been witnessed “is perhaps the end of the beginning”. His words are certainly an apt framing for one of the most exciting horizons in medical science. The story of immunotherapy drugs has radically altered both how we treat some of the most common and deadly cancers and our work applying those approaches to tackle even more of them.

An “Immuno Revolution” of cancer therapy is upon us, surging ahead now that the European Medicines Agency’s Committee for Medicinal Products for Human Use has recommended approval of a groundbreaking personalised cellular therapy for two common blood cancers. Full EMA approval for this CAR T-cell therapy – which engineers a patient’s own cells and sends them back into the body to seek and destroy their cancer – could come this summer, marking a pivotal moment in the fight against cancer.

CAR stands for chimeric antigen receptor. Last summer, it became the world’s first approved personalised cell therapy for cancer. It made headlines in the UK after a 31-year-old patient from Bristol, Mike Brandon, came to the Abramson Cancer Center of the University of Pennsylvania to receive treatment. Mike was battling acute lymphoblastic leukaemia, or ALL. Doctors at Penn Medicine collected Mike’s immune T cells, and reprogrammed them to attack leukaemia cells. These newly built cells were then infused back into his body, where they killed the ALL and put Mike into remission, against all odds. More than a year and a half later, he remains in good health.

This therapy has been successful for hundreds of patients – leading to overall remission rates of 80 per cent in children and young adults with ALL whose cancer could not be contained by standard chemotherapies. For patients with non-hodgkin’s lymphoma who have run out of other options, CAR T-cell therapy leads to remission 40 per cent of the time. Though the sudden promise of these approaches feels like an overnight sensation, the work required to perfect this therapy took decades. But CAR T therapy is here to stay and our approach to cancer care will never be the same again.

The therapy is not without its limitations. It can have serious side effects. And while it has proved powerful in blood cancers, getting a response in “solid tumours” is a bigger challenge. Research is under way to figure out why, with CAR T clinical trials for breast and prostate cancer, melanoma, the brain cancer glioblastoma and more.

CAR T therapy has drawn attention for its cost, too, but it has rewritten our concept of value: a one-shot gene therapy with the potential to rescue a child facing death is essentially unprecedented. History also tells us this is a solvable problem. When computers first hit the market, they were prohibitively expensive. No one would have guessed that in 2018 almost everyone would have a smartphone. Once the microprocessor was invented, it changed the game. This is the challenge CAR T therapies face, and there is reason to be optimistic that manufacturing improvements will help us scale up and scale out production.

CAR T therapy is only one of several new science-driven, patient-focused, immune-based approaches in the fight against cancer. Checkpoint inhibitor drugs represent a way to cut the brakes on the immune system and set it free to attack tumours. We are also learning we may need to prime a patient’s immune cells before these inhibitors can do their job. What was once a “valley of death” between promising laboratory studies and clinical trials in humans is rapidly narrowing, with quick translation between the bench and the bedside a chief priority for leading cancer research centres across the world.

We are of course mindful that cancer is an elusive, multi-faceted, and resilient opponent. Its ability to evade and adapt means the effort to finally beat it will require more than one approach. While we are not declaring victory, we are declaring hope. The expanding role of immune therapy, and in particular CAR T-therapy, represents the hope for a brighter future for all our patients.