Until recently, most patients with lymphoma who did not respond well to chemotherapy had a grim diagnosis, measured in months. However, new research into CAR-T therapy is offering new hope to these patients, with excellent long-term results.
Dr. Ofrat Beyar-Katz. Photography: Rambam HCC
Chimeric antigen receptor T-cell (CAR-T) therapy was developed more than a decade ago, and Rambam Health Care Campus (Rambam) in Haifa, Israel has been treating lymphoma patients with it for the past five years. The hospital is also the only one in Northern Israel authorized by Israel’s Ministry of Health to offer CAR-T therapy.
Dr. Ofrat Beyar-Katz, director of Rambam’s Cell Therapy Service, has been particularly focused on CAR-T research and its implementation in lymphoma patients not responding well to chemotherapy – the first-line treatment in most cancers.
Lymphoma is a type of blood cancer that develops in the immune cells, lymph nodes, and bone marrow. The first line of treatment for aggressive lymphoma is chemotherapy, requiring prolonged hospitalization with patients experiencing multiple side effects. The chemotherapeutic treatment is particularly difficult for older patients, who comprise the majority of patients. CAR-T therapy, on the other hand involves taking the patient’s T cells, engineering them to recognize and attack the cancer cells, and then returning them to the patient’s body. The accompanying chemotherapy is quite mild, aimed at preventing the body from rejecting the returning T cells. CAR-T therapy is administered as a convenient one-time option for patients with lymphoma.
Beyar-Katz commented on a recent presentation showing results after five years, after patients received CAR-T therapy , presented at the American Society of Hematology (ASH) conference in December 2023. The results were impressive: 83% of patients responded well, and no signs of disease were seen in 58%! When looking at subgroups of patients, the results are even higher: in patients who experienced a complete response in the first two years after CAR-T therapy, 91.5% experienced no disease progression!
“We have seen an excellent effect of CAR-T treatment in indolent, quiet lymphomas,” says
Beyar-Katz. She explains that in Israel, this treatment is currently given as a fourth-line therapy after at least three rounds of chemotherapy and immunotherapy (compared to second-line in aggressive lymphoma). Beyar-Katz points out that studies have shown good results even when CAR-T is used as a first-line treatment in certain patients.
Beyar-Katz is excited about the future of CAR-T therapy. “We are gaining more experience,” she says, “and seeing data showing that brain lymphomas can also be treated effectively with good results and fewer neurological side effects.”
Healthcare coverage by Israel’s HMOs is very advanced compared to the rest of the world.
Beyar-Katz points out that CAR-T therapy, as a second-line treatment, is approved according to criteria for chemotherapy-resistant cases or where there is a recurrence within one year from the first chemotherapy treatment. CAR-T patients suffer less, making this treatment highly suitable for older patients.
What is considered a good result?
Good results in research are debated among physicians and researchers. Still, it is generally accepted to speak of complete healing if no disease progression or recurrence appears within five years. Beyar-Katz explains, “If a patient asks me which treatment offers the best five-year outcome, I can say that CAR-T offers a 40-50% positive outcome. Life expectancy is low in more aggressive cancers, where, from the start, the patient does not respond to chemotherapy.”
Beyar-Katz is encouraged by the fact that about 30% of patients with a positive, partial one-month response show a complete positive response after three months. This is due to the fact that the CAR-T cells continue to clear the body from cancer cells. The good news, she explains, is that if the scan is clear after three months, there is a reasonable chance that the disease will not recur.
CAR-T therapy is good news for lymphoma patients and offers new hope for a disease with a short life expectancy.
Commentaires