We are on the cusp of a new age in cancer care.
Researchers from the Mayo Clinic and the University of Minnesota are employing stem cells as personalized, Robocop-like, cancer-fighting machines.
The two illustrious institutions are expected to receive the federal thumbs-up this fall to use these progressive stem cell treatments for particularly rare blood cancers – B-cell forms of lymphoma and leukemia.
Like Robocop purging Old Detroit of its cancer – crime – these Robo-stem cells hope to do the same for the real-life condition.
SEEK AND DESTROY – CAR T CELLULAR THERAPY
The Minnesota clinics are confident in their revolutionary stem cell therapies, dubbed CAR T cellular therapy.
This form of stem cell treatment involves doctor’s extracting white blood cells from the patient, genetically repurposing them in a lab, and then reinserting them as new, cancer-fighting machines.
While the treatment will be exclusive to blood cancers, the hope is the treatment will progress to battle solid tumor cancers, too.
“This is really the first approval of a genetically modified product for cancer therapy,” said Dr. Jeffrey Miller, deputy director of the Masonic Cancer Center at the University of Minnesota.
And if that proof of concept is viable, “we might be on the right track to get away from all of that toxic chemotherapy that people hate.”
Industry-funded clinical trials done by the Minnesota researchers has fueled optimism. In one analysis involving Kite Pharmaceuticals at Mayo, reported a seven-fold increase in lymphoma patients whose cancers vanished after CAR T therapy, compared to traditional chemotherapy.
“I often tell patients that T-cells are like super robocops,” said Dr. Yi Lin, a Mayo hematologist in Rochester. “We’re now directing those cells to really target cancer.”
OUT WITH THE OLD, IN WITH THE NEW
Even with the U.S. Food and Drug Administration expected to approve CAR T products made by Kite and Novartis in the fall, they don’t come without potentially harsh side effects.
T-cell infusions trigger immune system responses, that leads to fever, weakness, elevated heart rate, and kidney problems. Short-term memory and cognitive issues have also been documented. A Juno Pharmaceuticals trial had five patients die due to brain swelling; the CAR T trial was halted immediately.
Lin points out that brain swelling most occurred in adults. She foresees Kite’s CAR T stem cell therapy for large B-cell lymphoma being approved, as well as Norvartis’ therapy for acute lymphoblastic leukemia in children. Based on Juno’s trials, federal regulations may exclude CAR T therapies for patients whose cancers persisted through traditional treatments.
‘THEY’LL FIX YOU. THEY FIX EVERYTHING.’ – ROBOCOP
Today’s best bets in cancer care are chemotherapy and radiation. Following the treatments, doctors move stem cells, typically from a donor’s bone marrow, to rehabilitate the patient’s immune systems.
CAR T diverges in the patients receiving their own T-cells, which have been genetically modified, rather than a donor’s; this makes it less likely to reject the ‘foreign’ stem cells.
“It’s individualized medicine,” Lin simply said.
If CAR T is both approved and proven effective, the Mayo clinic expects a large surge of cancer patients annually. The treatment will be widely available, provided by large medical centers with experience in the therapies and their side effects.
The University of Minnesota is already advising physicians on referrals to other doctors and hospitals statewide, preparing for CAR T with potentially one-off symptoms.
“They can be a bit delayed and you can’t just keep people in the hospital to see if they develop these things,” Miller said.
Another potential accessibility barrier with CAR T, like many revolutionary treatments, will be costs. Prices are likely to exceed $200,000 per patient; it remains to be seen how insurers plan to cover these new cancer treatments.
According to Dr. Glenn Pomerantz, Blue Cross‘ chief medical officer, Blue Cross and Blue Shield in Minnesota is currently overseeing the evidence of CAR T’s effectiveness, basing their coverage policy on their findings, and whether it CAR T receives FDA approval.
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