Personalized tumour medicine thanks to innovative Car-T cell therapy
In addition to known cancer therapies such as surgery, chemotherapy and radiotherapy, CAR-T cell therapy has developed a targeted cancer therapy that recognizes and combats cancer cells. This pioneering procedure can be used to successfully treat patients with previously hopeless progression. In particular, this therapy offers hope to patients with aggressive lymphoma and certain forms of leukemia. Prof. Dr. Bertram Glaß, Chief Physician for Haematology and Cell Therapy at Helios Hospital Berlin-Buch, provides information on this innovative treatment method.
Fighting cancer with the patient's own immune system is the idea behind new forms of treatment in cancer medicine. CAR-T cell therapy is a form of immunotherapy that uses the patient's immune cells to destroy malignant cells in the body in a targeted manner and - unlike traditional chemotherapy, for example - leave healthy tissue and organs as unaffected as possible. Such targeted tumor medicine can lead to a more effective defense against tumors and to effective therapies with reduced side effects. Treatment with CAR-T cells has been a breakthrough for many patients, particularly for cancers that were previously difficult to cure, such as blood and lymphatic cancers, with response rates of up to 80 percent and long-term disease-free survival.
How does CAR-T cell therapy work?
Cancer cells are not visible to the immune system and can therefore spread throughout the body. The CAR-T cells are used to recognize and fight cancer cells. T cells or T lymphocytes are white blood cells that are responsible for the immune defense.
"Some cancer cells camouflage themselves so cleverly that they are not recognized by the immune system. CAR-T cell therapy can override this mechanism and ensure that the tumor can no longer evade the effects of the immune cells."
- Dr. med. Judith Niederland, Head Senior Physician of Stem Cell Transplantation | Helios Hospital Berlin-Buch
In CAR T cell therapy, T cells are taken from the body and then modified and multiplied in a laboratory. The T cells are equipped with so-called chimeric antigen receptors (CARs), enabling them to recognize tumour cells as foreign and destroy them. These modified, patient-specific T defense cells are then returned to the body as an infusion to destroy cancer cells.
CAR-T cell therapy is therefore a reprogramming of immune cells and not a classic drug. This preparation of the CAR-T cells currently takes several weeks, and bridging chemotherapy may be necessary in the meantime. Targeted immunotherapy also involves three days of preparatory chemotherapy.
From 'one-size-fits-all' to personalized therapy
"CAR-T therapy is certainly a first step and a possible basis for genuine personalized medicine in the future. There are other parallel approaches such as other forms of immunotherapy or the identification of cancer-specific genetic changes in the cancer cell that are targeted by special drugs. All of these approaches are combined in personalized tumour medicine and enable highly targeted treatment for precisely the disease of a specific patient."
- Prof. Dr. med. Bertram Glaß, Chief Physician Hematology and Cell Therapy
Compared to a one-size-fits-all approach, this can lead to more effective tumor defense and at the same time to effective therapies with reduced side effects. Personalization also makes it possible to adapt the treatment to the course of the disease, which makes it more precise and efficient overall than anything we have had in cancer medicine so far.
Response rate of up to 80 percent
Three groups of diseases are currently approved for CAR-T therapy in Germany and other European countries. It can currently be used for certain malignant diseases of the immune system and hematopoiesis - such as acute lymphoblastic leukemia (ALL) and some non-Hodgkin's lymphomas (NHL) as well as multiple myeloma. These are considered difficult to treat, especially in the event of a relapse after initial therapies. With CAR-T cell therapy, there is a response rate of up to 80 percent - and up to 40 to 50 percent long-lasting regressions, i.e. possibly cures. This means that four-fifths of all patients can be helped with the treatment.
Potential side effects following the infusion of CAR-T cells such as fever, chills, low oxygen levels in the blood, rapid heartbeat or low blood pressure can be treated well and will pass. Overall, the ratio between effect and side effect is considerably more favorable than with older methods such as high-dose chemotherapy, which are therefore increasingly being replaced by CAR-T therapy.
Innovative cell and gene therapies
The Helios Hospital in Berlin-Buch is one of the leading clinics for the treatment of malignant diseases of the immune system and haematopoiesis and is also involved in testing CAR-T cell therapy in clinical trials. CAR-T cell therapy has been offered as a standard in relapse therapy since 2019. Not every clinic can carry out this highly innovative therapy because it is linked to certain requirements. For example, a dedicated haematology center with extensive experience in the treatment of malignant diseases of the immune system and cell therapy must be available and the other strict requirements of the supervisory body, the Federal Joint Committee (GBA), must be met.
CAR T-cell therapy is a fascinating example of the possibilities offered by gene and cell therapy. Scientists believe that genetically modified cells could also lead to successful cures for other types of cancer in the future. The Department of Hematology and Cell Therapy at Helios Hospital Berlin-Buch, headed by Prof. Dr. Bertram Glaß, is helping to shape these further developments.
