Methodist Healthcare is seeing “exponential growth” in a new cancer therapy that relies on lab-modified immune cells.
Clinicians at Methodist’s flagship hospital and its adjacent children’s hospital in the South Texas Medical Center are also engaged in several clinical trials looking to advance the treatment, known as CAR T-cell therapy, for more cancers and even conditions beyond cancer such as autoimmune diseases.
“We are seeing that CAR-T therapy can be so powerful and immune suppressive that some people with autoimmune diseases like lupus or multiple sclerosis may be able to be helped,” said Dr. Paul Shaughnessy, medical director of Methodist Hospital’s Adult Blood and Marrow Stem Cell Transplant Program. “That would be a whole new area of treatment.”
Arming T cells to fight cancer
T cells are one of the immune system’s primary fighters against disease, latching onto cells infected with viruses and destroying them. These specialized cells are also able to recognize and target cancer cells.
But cancer often finds a way to outmaneuver this immune response, crafting complex defense systems that make it difficult for the T cells to identify and target it.
This is where CAR T-cell therapy comes in. CAR T cells are T cells that have been taken from the blood and genetically modified in a lab to more effectively identify and destroy cancer cells.
Researchers successfully modified T cells for the first time in 1989. In 2011 and 2012, cancer patients were treated with CAR T-cell therapy for the first time in separate trials, paving the way for approval by the U.S. Food and Drug Administration.
Methodist Hospital started offering the therapy as a standard treatment option about five years ago, Shaughnessy said, and its usage has skyrocketed since, even replacing some stem cell transplants — a decades-older procedure that uses high-dose chemotherapy along with a patient’s or donor’s stem cells to rebuild the immune system.
Methodist’s blood cancer and blood and marrow transplant programs, part of the national Sarah Cannon Cancer Network, has performed more than 4,000 adult transplants and hundreds of children’s transplants since it began in San Antonio in 1993, according to Shaughnessy.
Next generation of cellular therapies
So far, CAR T-cell therapy has proven most effective against blood cancers like leukemia, lymphoma and myeloma, where cancer cells circulate freely rather than forming into solidified tumors. It’s typically a last line of defense for patients who aren’t responding to other therapies.
“Maybe they’ve failed a bone marrow transplant previously,” Shaughnessy said. “These CAR T-cell therapies can offer curative treatment — not in every patient, but it can put the majority of patients into remission, and some patients look like they’ve been cured for the rest of their life.”
Researchers are investigating how to improve the therapy to target other cancers, which can be trickier, as well as certain autoimmune diseases.
Methodist Healthcare is participating in 10 of these trials, including one evaluating the use of T cells from healthy donors rather than a patient’s own cells. Researchers describe this so-called “off-the-shelf” approach as a way to potentially shorten the weeks-long wait typically required to manufacture a patient’s own cells, since donor cells could be prepared in advance and ready for immediate use.
Others are investigating multi-target CAR T-cell therapies to recognize more than one target on a cancer cell, ultimately improving effectiveness and reducing the risk of disease recurrence.
In addition to these cancer-focused trials, Methodist Healthcare is also participating in CAR T-cell clinical trials exploring new treatment options for autoimmune diseases and pediatric patients, including systemic lupus erythematosus, multiple sclerosis and scleroderma, among others.
One big challenge of CAR T-cell therapies, like other advanced cancer treatments, is its cost. Producing CAR T-cells can cost anywhere from $500,000 to $1 million for a single patient.
Most insured patients don’t pay that full amount out of pocket. Medicare and most private insurers cover the therapy for FDA-approved uses, though patients can still face significant costs for related expenses like travel and lodging.
Methodist is one of just a handful of programs statewide offering the treatment, drawing patients from as far as El Paso, Lubbock, San Angelo, the Rio Grande Valley and Corpus Christi, Shaughnessy said.
Additionally, researchers at UT San Antonio and Southwest Research Institute are among those working on bringing costs down, aiming to develop lab technology that would automate a part of the manufacturing process and lower the cost of CAR T-cell production. Their project is still in early development.
“This is a therapy that has helped people who haven’t responded to anything else,” said Carlos Cantu, a research engineer at Southwest Research Institute and co-investigator on the project. “We’re trying to make it more accessible to everyone else.”
