We’re adding new tools to our cancer-fighting arsenal.
This month, University of Minnesota Health became certified to offer patients a new immunotherapy drug called Yescarta™ for the treatment of refractory or relapsed diffuse large B-cell lymphoma. A few days later, another drug known as Kymriah™ also received Food and Drug Administration approval for use treating the same type of cancer.
Both drugs are part of an emerging class of treatments, called CAR T-cell therapies, that harness the power of a patient’s own immune system to kill cancer. Kymriah™ received initial FDA approval in 2017 for the treatment of pediatric leukemia. Now, it can also be used on lymphoma. University of Minnesota Health is one of only a few health systems across the nation offering both Yescarta™ and Kymriah™.
CAR T-cell therapies offer some patients another option in addition to traditional treatments, such as chemotherapy, radiation or a blood and marrow transplant. Though these therapies carry their own set of risks, the side effects are different from those of other cancer treatments and have a shorter window for complications.
For 58-year-old Burnsville resident Colin Cooley, CAR T-cell therapy was his only chance at survival.
In 2014, Cooley had been walking on a treadmill for about 10 minutes when his leg started to ache between his knee and hip. Days later, Cooley was helping a family member move a couch when he was overcome with dizziness. The spinning sensation forced him to sit down.
These symptoms prompted him to visit a local clinic. Tests showed elevated levels of white blood cells. His primary care physician then referred him to a hematologist for more testing, which revealed a startling diagnosis: Follicular Non-Hodgkin Lymphoma.
“I picked up the phone on the freeway. I’m glad I was sitting down but I shouldn’t have been driving,” Cooley said. “They told me I had cancer. It was stage three and I was frightened. It sounded pretty advanced.”
Follicular Non-Hodgkin Lymphoma is relatively common and typically grows more slowly than other blood cancers, according to University of Minnesota Health Hematologist/Oncologist Veronika Bachanova, MD, PhD. But it’s hard to cure.
Cooley’s oncologist at the time started treating him with chemotherapy. After six months, the cancer appeared to be in remission. He returned to the oncology clinic periodically for small doses of chemo drugs designed to keep the cancer from coming back. It was at one of these appointments when a routine scan exposed the worst: Cooley’s cancer had returned.
This time, it had morphed into the more aggressive diffuse large B-cell lymphoma, which doesn’t respond well to chemotherapy treatments.
His next treatment was more demanding, Cooley recalled. Every six weeks he was admitted to the hospital where doctors would administer chemo over the course of three days.
“It wasn’t working like we’d hoped, so my oncologist asked if I wanted to enroll in a clinical trial with University of Minnesota Health,” Cooley said. “My doctor told me that they basically wrote the book on treating this cancer.”
The clinical trial was for a drug called Kymriah™.
“When Colin’s lymphoma relapsed and proved resistant to chemotherapy, he had very few other options,” said Bachanova, who also treated Cooley. “At that point, he had about three months to live.”
Kymriah™ and the newly approved Yescarta™ work in similar ways. Both are a type of CAR T-cell therapy, which is itself part of a larger group of innovative treatments called immunotherapies. During CAR T-cell therapy, specialists extract a large number of T-cells from a patient’s blood. The T-cells are then genetically modified to target cancer. After receiving the modification, the cells are then reinserted into the patient’s body, where they go to work killing cancer cells.
In late October 2016, Cooley received an infusion of his own, modified T-cells. The cells immediately began fighting his lymphoma.
One day, CAR T-cell therapies could eliminate the need for blood and marrow transplants, according to Pediatric Blood and Marrow Transplant Physician Heather Stefanski, MD. Stefanski helped lead the study that brought Kymriah™ to market pediatric acute lymphoblastic leukemia.
“Immunotherapies like these are some of the biggest advances that we’ve had in years,” Stefanski said. “In the next five years, CAR T-cell therapies will be booming. They’ll give patients more options for survival, much like the blood and marrow transplant did.”
50 years ago, a University of Minnesota care team led by Robert Good, MD, performed the world’s first successful matched, related donor blood and marrow transplant. Blood and marrow transplants have become a standard of care for the treatment of blood cancers. They are also used to treat other rare disorders like adrenoleukodystrophy and epidermolysis bullosa.
However, a blood and marrow transplant is also a notoriously grueling therapy that comes with many severe, long-term side effects. Now, University of Minnesota Health physicians, in partnership with researchers at Masonic Cancer Center, University of Minnesota, are applying the same innovative spirit that led to earlier breakthroughs to new immunotherapy research.
“The difference with CAR T-cell therapy is that we can more precisely target the cancer,” Stefanski said. “This is where all of medicine is going. It’s very personalized and we’re matching specific treatment to specific people.”
In a multicenter clinical trial of more than 100 adults with relapsed large B-cell lymphoma, the remission rate after treatment with Kymriah ™ was about 60 percent. Roughly 40 percent of patients achieved a complete response.
One month after receiving cancer-killing T-cells, Cooley’s lymphoma was already retreating. While many people can experience harsh side effects, like temporary memory loss and seizures, his only side effects throughout the treatment were fever, fatigue and minor nausea.
He remains cancer-free a year and a half later.
“When the unknown of a clinical trial is better than the known of a failed treatment, it became a way out [of cancer],” Cooley said of his participation in the clinical trial. “I was thrilled when the FDA approved it and it’s amazing that my participation helped it come to fruition for more patients.”