A Revolutionary Step Towards Fighting Cancer

Ten million people around the world get cancer every year. Despite the rapid development of oncology, people have remained on the same page for a long time called "there is no effective treatment." Scientists around the world are continually looking for new ways to resolve this issue. And now, thanks to the development of genetic engineering, molecular biology, and chemistry, there are many unique methods, drugs, and schemes appearing.

The specific method that is going to be covered in this article is CAR-T. Of course, being a medical student, you could have come across this article in search of more info on some urgent papers. In this case, better turn for help to professionals from because after finishing reading this article, you'll definitely want to learn more on the topic and may very well miss the deadline!

Where It All Started

In 2011, five-year-old American Emily Whitehead was diagnosed with acute lymphatic leukemia. The standard therapy proved powerless for Emily. And a year later, everyone was sure that the girls' days were over. Luckily, the Children's Hospital in Philadelphia was able to include Emily in the clinical trial of the latest method - CAR T-cell therapy. No one knew how the kid would react to an experimental treatment, but there was no other chance. Despite serious complications, Emily had recovered. And the doctors were surprised and happy to find that there were no tumor cells in her body! It's been years since then. Emily goes to school, plays football, walks the dog, and lives like any other healthy kid.  This success story attracted the attention of the public to the research, which had been conducted for more than twenty years. In 2017, the American Society of Clinical Oncology had announced the CAR T-cell therapy method the main achievement of the year.  At that time, Kymriah and Yescarta were officially registered in the USA. It is not about drugs, but about a fundamentally new technology of treatment.

What Is the Point of CAR T-Cell Therapy?

Therapy with chimeric antigen receptors (CAR) T-cells involves using one's body's immune system to fight cancer. In short, CAR-T cell therapy is a type of immunotherapy. Individual immune cells - T-lymphocytes - play a crucial role in the recognition and destruction of enthetic cells. But our lymphocytes themselves are not strong enough to deal with tumors. That's why the idea of genetically engineered one was proposed to improve the detection of tumor cells and enhance the immune response. Thanks to the outside part of the immune cell, the chimeric recipient is able to recognize the right tumor cells very precisely. And the "inner" parts are responsible for the performance of lymphocytes.  After all, T-lymphocytes should not only be activated in contact with the target but also maintain its activity for many weeks to cope with the tumor. As a result, the patient's immune cells make an ideal "killing machine", destroying the tumor. The only thing left is to multiply these cells, inject them back into the patient, and then monitor one's condition.

Joy and Challenges

The first results of the new technology are impressive. CAR T-cell therapy responds well to 80-90% of patients with lymphoblastic leukemia and lymphoma. And these are the most difficult patients, who cannot be treated by any standard methods. First, the field of successful clinical implementation of this therapy is still quite limited. It only concerns tumors that consist of B-lymphocytes and their predecessor cells. So this treatment covers only leukemia and lymphoma. Doctors are looking forward to the appearance of CAR T-cell therapy methods, which will be valid for other tumors as well. Hundreds of clinical trials are being conducted around the world, primarily in the USA and China. If even a small percentage of them succeed, it will change the modern oncology treatment. The other problem is toxicity. Cytokine syndrome turned out to be a severe complication. A robust immune reaction is sometimes associated with very high fever, high blood pressure, cardiovascular, and respiratory problems. There are also other dangers. Therefore, the new therapy requires careful monitoring of patients and their treatment by experienced doctors. And finally, it's a revolutionary technology that requires unusual approaches. And the price issue is one of the extremely painful ones. For the treatment of one patient using a "ready-made" technology, Kymriah or Yescarta requires payment of hundreds of thousands of dollars. 

Wrapping Up

When CAR T-cell therapy becomes more accessible, and the issue of its long-term effectiveness becomes more explicit, its scope of application will expand. Maybe one day, it will partially replace traditional methods, including chemotherapy and bone marrow transplantation.  Leukemia can be disastrous, mainly when it affects children. However, the great hope lies in advanced medicine and high-quality patient care.

Jean Linder

Jean Linder is a writer and photographer from Pittsburgh, PA.
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