The Triple Helix @ UChicago

Spring 2018

"New Hopes in the Fight Against Cancer" by Philip Jordache

 

Within the past year, a new type of cancer treatment has surfaced in the US. This novel technique recruits the body’s own blood cells to combat the deadly disease—this represents a significant break from the more conventional approach, acted on by most currently existing anticancer drugs, which damages DNA contained in tumor cells and subsequently destroys them. The name of this newcomer to cancer care is Kymriah. 

Specifically, the treatment targets CD19 CAR T-cells, a type of white blood cell that has been modified via the introduction of a chimeric antigen receptor (CAR), a hybrid protein containing both antigen-binding domains and T-cell-receptor-like signaling structures. These cells target B-cell surface proteins, known as CD19 proteins, that are expressed in many B-cell cancer malignancies. This configuration enables the cells to very efficiently target tumor cells via the specificity of the antigen-binding domains. 

Developed by the pharmaceutical company Novartis AG, the treatment represents the newest in a line of cancer treatments whose development has been accelerating over the past few years, known as immunotherapy. As the name suggests, treatments of this sort recruit agents of the immune system to combat cancer with a degree of efficiency and specificity absent from more conventional treatment methods. This efficacy has certainly been reflected in the results. In one study, 15 patients experiencing various forms of cancer, including B-cell malignancies, B-cell lymphoma, indolent lymphoma and chronic lymphocytic leukemia were treated using anti CD-19 CAR T-cells. Of these patients, eight achieved complete remissions, another four achieved partial remissions, one had stable lymphoma, and the remaining two were not evaluated. While the study was limited to a fairly small sample of patients, prompting the authors to stress room for improving effective anti-malignancy, the importance of the results in evincing the efficacy of anti-CD19 CAR T-cell therapies, such as Kymriah, for advanced B-cell lymphomas is clear. Many other studies have yielded similar success rates regarding cancer remission, and the introduction of Kymriah to the public has seen a high proportion of successful cancer eliminations as well. 

Kymriah has been introduced for use in combating leukemia in its advanced stages, in both children and adults. Of course, there exists an immediate need to introduce similar methods to treat other types of cancer in order to improve patient outcomes. Accordingly, a great deal of research is underway to evaluate Kymriah’s potency against other cancer types. Thus, the issue of using this procedure to improve treatment for other types of cancer is, to a large extent, being addressed. There exists another, more pressing issue to address regarding the Kymriah treatment approach—it typically costs at least half a million dollars, and can often prove even more expensive than this figure due to a variety of other factors. Not only this, but many similar therapies have very similar price ranges. Of course, this proves quite restrictive with regards to who can afford such a treatment—many in desperate need will likely lack access to this great advance in cancer care while the price remains so high for the foreseeable future. In light of the massive costs of cancer care, how can we lighten the load for financially insecure patients?

One answer could be to tailor treatments to target patients’ individual needs to an even greater extent than is seen in Kymriah, using the most unique feature of every individual: the genome. Cancer can arise due to a number of different mutations and environmental factors. Much attention has recently been drawn to treating various illnesses and diseases (even beyond cancer) by tailoring treatments to individuals, using their DNA to precisely pinpoint the genetic sources of their maladies. These sources are then used to address each person’s needs for cancer care with unprecedented precision and efficacy. The main difference here would be inexpensive diagnostic tests. Many genetic tests targeted towards detecting presence or absence of specific genetic risk factors are available for only a few hundred dollars. If a genetic test confirms the presence of a given risk factor, potential treatment options can become much easier to evaluate, since the specific needs of each patient would become much more clear. Genetic testing can most effectively be used as part of holistic treatment, in order to cover the risks patients carry for cancers and other illnesses on the basis of interaction of genes with lifestyle and environment, as this relationship is often the ultimate determinant of disease contraction. In this way, extraneous measures and treatments that could cause significant harm, which run rampant in the cancer care sphere, can be avoided just as with Kymriah, and the cost of cancer remission would greatly decrease as well. If such tests reveal no risk, patients can save much effort and money on the road to pinpointing the sources of their maladies, or even in the process of simply maintaining their health. Even if genetic test results call for treatments such as chemotherapy, these are only a fraction of the cost of the new personalized cancer treatments such as Kymriah. In a world where novel therapies cost an arm and a leg, holistic treatment that makes use of inexpensive genetic tests could provide a ray of hope for patients in need until these new therapies become more common. 

 

References

[1] "CAR T Cells: Engineering Immune Cells to Treat Cancer." National Cancer Institute. Accessed June 04, 2018. https://www.cancer.gov/about-cancer/treatment/research/car-t-cells

[2] Kochenderfer, James N., Mark E. Dudley, Sadik H. Kassim, Robert P.T. Somerville, Robert O. Carpenter, Maryalice Stetler-Stevenson, James C. Yang, Giao Q. Phan, Marybeth S. Hughes, Richard M. Sherry, Mark Raffeld, Steven Feldman, Lily Lu, Yong F. Li, Lien T. Ngo, Andre Goy, Tatyana Feldman, David E. Spaner, Michael L. Wang, Clara C. Chen, Sarah M. Kranick, Avindra Nath, Debbie-Ann N. Nathan, Kathleen E. Morton, Mary Ann Toomey, and Steven A. Rosenberg. Advances in Pediatrics. February 20, 2015. Accessed June 04, 2018. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4322257/

[3] Kochenderfer, James N., Mark E. Dudley, Sadik H. Kassim, Robert P.T. Somerville, Robert O. Carpenter, Maryalice Stetler-Stevenson, James C. Yang, Giao Q. Phan, Marybeth S. Hughes, Richard M. Sherry, Mark Raffeld, Steven Feldman, Lily Lu, Yong F. Li, Lien T. Ngo, Andre Goy, Tatyana Feldman, David E. Spaner, Michael L. Wang, Clara C. Chen, Sarah M. Kranick, Avindra Nath, Debbie-Ann N. Nathan, Kathleen E. Morton, Mary Ann Toomey, and Steven A. Rosenberg. Advances in Pediatrics. February 20, 2015. Accessed June 04, 2018. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4322257/

[4] Maude, Shannon L., David T. Teachey, David L. Porter, and Stephan A. Grupp. "CD19-targeted Chimeric Antigen Receptor T-cell Therapy for Acute Lymphoblastic Leukemia." Blood Journal. June 25, 2015. Accessed June 04, 2018. http://www.bloodjournal.org/content/125/26/4017?sso-checked=true

 
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