By harnessing the full force of a patient's immune system, the targeted approach of CAR T-cell therapy makes it possible to mount a highly effective attack against certain cancers. Dr. Robert Collins, Director of UT Southwestern’s Blood Cancers Program and a leader in immunotherapy, explains how advances in this field offer hope to pediatric and adult cancer patients.
it's a rapidly emerging form of cancer treatment altering our immune cells in the lab so they can find and destroy cancer here to explain the science of car T cell therapy is dr robert Collins, director of the cellular therapies program at UT Southwestern. Glad you could join us dr Collins. There have been a lot of new developments related to cell therapy just in the last couple of months. But let's start with the basics, tell us what car T cell therapy is. Car T cell therapy is a new approach to cancer therapy which harnesses the patient's own immune system to carry out a very effective attack against cancer cells. And essentially what's done is that a patient with some sort of cancer where you run out of things to do to treat them. They have immune cells removed from their bloodstream. And then those immune cells T cells for the most part are taken to the laboratory and using gene therapy, we put jeans in those t cells to redirect them against the patient's cancer cells the target which is on the patient's cancer cells. So this is all done in the laboratory and then these cells are grown up and then re infused into the patient. These cells find their way to the cancer cells latch onto that target and carry out really a devastating attack against the cancer cell. And we're seeing patients who are otherwise absolutely incurable. Um achieving long term remission, essentially cured by this therapy dr Collins, how does car T cell therapy differ from chemotherapy, chemotherapy and in general targets sort of intracellular vulnerabilities of the cancer cells. And so they it oftentimes work but oftentimes it doesn't and it depends on whether or not the particular cancer cell happens to have that vulnerability, the car T. Cell. It just works in a completely different way. It doesn't care what's going on inside the cancer cell. It just cares if that cancer cell has a particular target on the surface and if it does it's gonna latch onto it and bring the full force of the most effective aspect of the immune system. The T cell. The full force down on that on that cancer cell and kill it. So the key there is does the cancer cell have the target? And if it does it's gonna have a hard time surviving that attack. We saw this last couple of weeks that Car T cell therapy has been approved for treatment of multiple myeloma. Is that the same scenario for patients who have run out of options with traditional therapies? Yeah. This is really an exciting advance patients with multiple myeloma is a bone marrow cancer who had run out of things to do and we're really very close to the end. Um These patients were given car T cell therapies and had a high rate of complete remissions and some of these remissions are still ongoing. Their survival is definitely prolonged. Actually Larry Anderson who's the head of our multiple myeloma program was the co first author on this paper which was in the new England journal. It's led to FDA approval. It is a new paradigm for treatment of multiple myeloma patients and it suggests all sorts of additional research questions for down the line, for example, um utilizing different car T cell constructs but especially utilizing this approach that if it works so well in advanced disease, it ought to work earlier in the course of disease much better. And so that's that's where this field is headed, both for cancer and for multiple myeloma type of bone marrow cancer. Are their patients who are ideal for this And are there patients in whom the therapy is not appropriate for? Right now we have four FDA approved products and we're a clinical site for three of these. And we will be for the fourth which was just approved. These are for patients who have advanced and refractory disease, acute lymphoblastic leukemia in Children and young adults. Um certain types of non Hodgkin's lymphoma, multiple myeloma. Um so they have the have to have the right disease and they have to have the right characteristics of the disease. And right now it's limited to patients who have advanced and refractory disease dr Collins. I know you're involved in a lot of clinical research at UT Southwestern in this specific area of car T cell therapy. Tell us about the trials that are ongoing at UT Southwestern now. Now we have a lot going on here and and I really, I should just acknowledge my colleagues who are really leading this on the pediatric side sam john and Andy cho on the adult side. Sarah cohen larry, Anderson ravine, Ramakrishnan blanca con saga in the laboratory Alex Zhang. So these guys are really doing the work. We're doing a lot with pharmacologic malignancies. Again looking at T cells earlier in the course of disease, we've also got some studies going on with with solid tumors for example, sarcomas, gastric cancer, kidney cancer. Another approach that we're really excited about is um donor car T cells which are specifically engineered to and actually using CRISPR technology to make it so that these donor T cells will end graft in the patient. There's just this whole panel of T cells that have been made from all sorts of different donors with all sorts of H. L. A. Molecules so that we can pull out the right cells and matching to the patient. You know just sort of like that. Instead of having to wait for manufacturers tell us what you think car T cell therapy is going to look like in five years and what diseases we might be treating successfully. Let's say over the next five years we're gonna see a lot of new car T cell constructs just increasingly sophisticated. And the other thing is that yeah you can basically design the car T cell to do whatever you want. We're focused on myeloma myeloma and other malignancies. But you can you can design a car T. Cell which will attack anything. So we begin to imagine using car T. Cells for infectious diseases, for auto immunity for transplant tolerance. And um I'd say it's it's earlier in that aspect of the field but for sure um groups have done pre clinical work and are bringing this out to the clinic within a fairly short while for the long term and I think there's just no doubt that in blood cancers like what I deal with that this is going to be the mainstay of therapy and it's going to be effective enough that it's can perhaps essentially the only therapy it's gonna be really moving into the fields of auto immunity and infectious disease and transplantation tolerance, dr Collins. This is an area of great promise. We want to thank you for joining us today to teach us about car T. Cell therapy and for delineating all the opportunities for us to improve lives and in patients with cancer and other diseases. Thanks again. Thanks very much. Thank you for joining us until next episode. Stay safe and stay healthy.