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CAR-T Cell Therapy: How It Works

March 25, 2022

Just hearing that you have cancer can be overwhelming. The real challenges begin when your doctor explains the specifics of cancer treatment. Suddenly, in addition to coping with a scary new diagnosis, you have a whole new vocabulary to learn and master. What is a T-cell, again? What do you mean by “infusion?” Underneath it all, you want to know how long it will take before you are cancer-free and feeling like yourself again.

CAR-T Cell therapy is one of the most exciting cancer treatments. We’ll discuss how it works, which kinds of cancer it can treat, and how to determine if you’re a good candidate.

What is CAR-T Cell Therapy?

CAR-T cell therapy is a type of cancer immunotherapy treatment. The word “immunotherapy” basically means a therapy that boosts your immune system response to better fight cancer.

The CAR-T therapy process explicitly targets cancerous cells so your immune system can identify and destroy them quickly and efficiently. 

You may not already know this, but your body’s immune system is brilliant. Your immune system’s “smart” T-cells can identify cells that become infected and turn cancerous. Once cancerous cells are detected, your immune system begins manufacturing a specific type of blood protein called an “antibody.”

This antibody is deliberately designed to target and eliminate the cancerous cells until they’re all gone. With a boost from the CAR-T cell therapy process, your immune system gets even better at doing its job to clear your body of cancerous cells.

How Chimeric Antigen Receptor (CAR) T-Cell Therapy Helps Your Immune System

There’s no doubt that “Chimeric Antigen Receptor” is a mouthful. Once you understand how this type of immuno-therapy got its name, you’ll also understand precisely how it works.

T-cells are the cells in your body’s immune system that fight off threats like mutating cancerous cells. Your body’s T-cells might fight off multiple types of threats at any time. CAR-T cell immunotherapy works to temporarily reprogram all the T-cells in your body’s immune system to stop what they’re doing and go to battle with cancer instead.

It does this by adding a special messenger to your T-cells. This messenger is called a “car” because it gives your T-cells specific directions about where to go next. Once the “car” is installed onto your immune system’s T-cells, they’ll all turn and fight the cancer cells together. 

How Does the CAR-T Cell Therapy Process Work?

While your process may differ slightly depending on your specific diagnosis, this is a basic overview of how the process works.

First, your provider will do a blood draw to remove your T-cells. Next, the “car” messengers are added to your T-cells. While your T-cells are getting their driving directions, you’ll be preparing for your therapy by undergoing low-dose chemotherapy and other therapies your provider may recommend.

Once your T-cells are appropriately equipped with their “car” messengers, they get sent back into your body to do their work. This process is known as an infusion. After your infusion is complete — usually just a matter of hours — your provider will monitor the progress of the T-cells as they go to war against the cancerous cells in your body.

How long it takes for your T-cells to finish the job depends on your specific diagnosis, the stage of cancer, and the type of therapy recommended to treat it.

Managing the Side Effects of CAR-T Cell Therapy 

CAR-T therapy can cause severe side effects like many other cancer treatments. Serious side effects can cause antibody-producing B-cells and infections to mass die-off and cytokine release syndrome (CRS), one of the most frequent side effects. 

T-cells release cytokines, chemical messengers that help stimulate and direct the immune response. Infused T-cells flood the bloodstream with cytokines in CRS, causing dangerously high fevers and significant drops in blood pressure. CRS can even be fatal in some cases. 

Although CRS is a severe side effect of CAR-T cell therapy, it typically means that T-cells work effectively in your body. CAR-T therapy makes patients with the most extensive cancer more likely to experience severe CRS. Tocilizumab, a drug that initially treated inflammatory conditions, is typically used to manage this severe side effect. Tocilizumab blocks cytokine activity secreted in large amounts by T-cells and macrophages. 

CAR-T cell therapy can also cause severe neurologic side effects, including extreme confusion, seizure-like activity, and impaired speech. Researchers are still unclear about what causes these severe neurologic effects, otherwise known as immune effector cell-associated neurotoxicity syndrome (ICANS). 

Studies show that Tocilizumab is more effective in managing CRS than ICANS, and ongoing cancer research on various treatments for severe side effects shows promising results. 

What Types of Cancer Can Cancer Immunotherapy Treat?

The Leukemia & Lymphoma Society reports that the following types of cancer have been treated with the CAR-T process to date:

  • B-cell precursor acute lymphoblastic leukemia 
  • Relapsed or refractory large B-cell lymphoma
  • Diffuse large B-cell lymphoma (DLBCL)
  • Primary mediastinal large B-cell lymphoma
  • Follicular lymphoma
  • High-grade B-cell lymphoma
  • Chronic lymphocytic leukemia (CLL)
  • Multiple myeloma
  • Other types of blood cancers

New CAR-T treatments are continually being developed, tested in clinical trials, and monitored for results. If you’re interested in learning more about cancer immunotherapy, discuss current and evolving CAR-T options with your healthcare provider.

About Nashville Oncology

As a proven leader in oncology and hematology, we are committed to cancer research to improve the future of cancer care. Nashville Oncology offers access to world-class clinical trials to those in our community. Learn more about our clinical trial opportunities and if they are right for you