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A conversation with Stanford Health Care oncologist David Miklos, M.D., Ph.D., about the promise of CAR-T therapy
David Miklos, M.D., Ph.D., is a blood and marrow transplant specialist, hematologist, and medical oncologist at Stanford Health Care. He is also Associate Professor of Medicine and the Clinical Director of Stanford’s Cancer Cell Therapy Program.
What is CAR-T Therapy?
As part of CAR-T therapy, we take the patient’s own immune cells — T cells — from their blood and, in a laboratory, reengineer them with a virus to produce chimeric antigen receptors (CARs), which are cell receptors that target proteins on cancer cell surface. We then put the reengineered immune cells back into the patient’s blood, where they multiply and attack the cancer. Essentially, we use the immune system that protects you from cancer in the first place and we supercharge it. These cells create an immune memory, like the immune cells we all have protecting us from chicken pox reactivating. They live a long time, potentially a lifetime.
What patients are benefitting from CAR-T?
The FDA has approved CAR-T therapy for patients with certain types of lymphoma and acute leukemia, who did not benefit from chemotherapy treatments. Under the direction of Dr. Crystal Mackall, Stanford is developing new CAR-T therapy constructs. The goal is to use the therapy on solid tumors, like lung cancer and breast cancer. We are already working with other institutions to test cancer cell therapy on patients with different conditions such as lung cancer and sarcoma.
Will this treatment replace chemotherapy?
This is just the beginning. We’re hoping to use this therapy rather than putting patients through the toxicity and difficulties of chemotherapy. In January 2018, we will participate in a study comparing the safety and effectiveness of CAR-T versus standard chemotherapy for patients with relapsed diffuse large B-cell lymphoma (DLBCL).
What are the side effects?
After we infuse patients with their reengineered immune cells, 90 percent of them experience a reaction that feels like a bad flu — achy muscles and a fever. They feel the body’s immune system at work. Some patients also acquire neurological toxicities, which result in tremors and memory loss. We keep them in the hospital, and we can slow down the growth of the immune cells to keep the side effects in check.
How big a deal is this?
It’s huge. It’s exceeding anything I could ever have imagined two years ago. The people we’re treating successfully are people who had no hope of surviving their cancer. And we’re building new ways to make CAR-T even more successful. It’s crazy successful and crazy exciting.
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