CAR-T cell therapy in myeloma: Q&A
Haematology What makes CAR-T cell therapy different from current myeloma treatments? ...and other frequently asked questions answered by Dr Rakesh Popat Consultant haematologist at University College Hospital, London.
What makes CAR-T cell therapy different from current myeloma treatments?
CAR-T cell therapy represents a completely different way of killing myeloma cells compared to current ways of treating myeloma. As part of CAR-T cell treatment, we remove patients’ own T cells and then activate and redirect them to target the myeloma.
These are living cells which will be able to circulate around the body just like any other blood cell. As a result, CAR-T cells are dynamic therapies which react when they come into contact with their target (myeloma cells). When this happens, they release chemicals (cytokines) to recruit other immune cells to join with them to kill the myeloma.
In this process the CAR-T cells “educate” the immune system to recognise and fight against myeloma. Unlike drugs, CAR-T cells can persist in the body for years and can also divide to give rise to new cells. The potential of CAR-T cells to provide long-term control is why this type of treatment has drawn so much attention and distinguishes it from standard approaches, i.e. where a drug needs to be taken continuously to achieve control.
Finally, CAR-T cells kill myeloma cells from the outside of the cell (as opposed to chemotherapy drugs, or proteasome inhibitors which kill the cell from the inside). This means that CAR-T cell therapy may be more resistant to the effects of the genetic subtype of the myeloma cells, which can influence how well a patient’s myeloma responds to a particular treatment. We still anticipate challenges, though, in making sure that the CAR-T cells keep on working to control the myeloma, particularly in patients with ‘higher-risk’ genetic subtypes.
What questions do you most want answered about CAR-T?
We are still in the infancy of CAR-T development for myeloma. There are so many questions still to answer. Most of all, I want to know if this will be a safe and effective treatment, particularly for those patients in which other treatments haven’t worked.
What do you hope will be the long-term impact of CAR-T therapies on myeloma treatment?
We all hope that this type of treatment can lead to the long term control of myeloma, as the immune system regains control of the cancer. If this turns out to be the case, CAR-T cell therapy could revolutionise the outcomes for myeloma patients in a way that no other treatment has. I hope that as we learn more, we will be able to offer this treatment to more patients and at earlier stages in their treatment pathway.