First patients treated with CAR T therapy



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King's College Hospital has treated adult patients with the new pioneer treatment

Dr Victoria Potter and Mike Simpson

King's College Hospital in south London has become the first hospital in the UK to use the newly approved CAR T (chimeric antigen receptor T cell) therapy to treat adult patients with lymphoma.

CAR T therapy is a complex immunotherapy that is developed personally for each individual patient. It involves the collection of T cells – the immune system cells that recognize and kill viruses – from the patient, reprogramming them to recognize the cancer cells and infusing them back into the patient so that they attack the cancer.

Currently, CAR T therapy is being used on patients selected from King's with a recurrence of lymphoma – a cancer that starts in the cells fighting the infection of the immune system. These cells are found in the lymph nodes, spleen, thymus, bone marrow, and other parts of the body.

Dr. Reuben Benjamin, King's hematologist, who led the clinical trial that conducted King's first T cell therapy, said, "King's has long been at the forefront of pioneering new treatments for blood diseases. therapy. It has been shown in trials to cure some patients, even those with advanced cancer, when other treatments failed.

Treatment is effective in about 40-50% of cases, including patients who do not respond well to chemotherapy, but have a unique set of side effects, including neurotoxicity, in the short term. Dr. Benjamin added: "Patients receiving treatment may experience a number of unpleasant side effects from high fever; vomiting; and diarrhea to confusion; aphasia (difficulty understanding or speaking); and loss of consciousness.

King & # 39; s has been at the forefront of this therapy by bringing researchers and physicians together as part of King's Health Partners, transforming the latest research into pioneering new treatments for patients.

As a result of this partnership, all CART patients are screened for anxiety and depression. Any patient with symptoms will receive mental health support to deal with the difficult effects of treatment. This makes King unique, as no other UK hospital offering CAR therapy associates this physical and mental health treatment.

One of the first patients to receive treatment was Mike Simpson, 62, a lawyer from Durham. The father of two married children was diagnosed with stage 4a of Diffuse Large B-Cell Lymphoma, a rapid form of blood cancer in 2015, after discovering a lump in the neck. He underwent chemotherapy and radiation at his local hospital and went into remission. Ten months later, he fell and was treated again. After entering remission for the second time, the cancer returned.

Mike said, "In October 2018, I began to experience back pain, stomach discomfort and severe vomiting, so I went through more tests and received the news that the cancer was back. Dr. Wendy Osborne and her colleagues at the North Cancer Center (NCCC) at Freeman Newcastle Hospital explained CAR T therapy, which looked very promising, so when I had the opportunity to have therapy at King & # 39; s , I jumped at her and very grateful the NCCC team put me forward. "

Mike came to the King's in late 2018 for pre-evaluation and had his cells collected in early January 2019. While they were sent to the US for modification, Mike received treatment to ensure that his lymphoma remained under control while this process takes four. weeks. Once the CAR T cells were manufactured, he received conditioning chemotherapy to prepare for the infusion of modified T cells, which he received in February.

Mike said: "The King's team has explained everything about the treatment and the possible side effects. Despite this, it was still a big shock for me and my family when I got sick a few days after the infusion. It was not a walk in the park. I spent almost a week in intensive care and, when I was well enough to go back to the ward, I had to relearn the basic tasks, such as climbing stairs. I was fortunate to have the support of my wife and children, who had to watch me go through the changes hoping they would be temporary at all times.

Despite the initial adverse reaction to therapy, Mike responded well to treatment and is working for remission. He is back home, spending time with his young grandchildren and regaining his strength. Mike is hopeful for the future, including a return to work, but acknowledges how lucky he is. "I am incredibly grateful to have had the opportunity to do this therapy because I know it is an expensive and unique treatment. I describe it as my treatment of L'Oreal … because I'm worth it, "he joked.

Dr. Victoria Potter, a hematologist and stem cell transplant director at King's, said: "In cases like Mike's, CAR therapy is the last resort when other treatments have failed. While this does not work for everyone, as we have seen in clinical studies, this type of personalized medicine offers real hope for patients with lymphoma who would otherwise have limited options. We are very hopeful that this treatment will be a change factor for our patients. "

The NHS is providing CAR T therapies for children and young people with B-cell acute lymphoblastic leukemia and adults with diffuse large B-cell lymphoma and primary mediastinal B-cell lymphoma in England.

Simon Stevens, chief executive of NHS England and NHS Improvement, said: "The CAR-T is a great promise and it's great to see that NHS patients are among the first in the world to benefit. The start of this treatment marks the beginning of a new era of personalized medicine, and is part of the update on the cancer services that are set out in the NHS Long-Term Plan. "

A panel of medical experts decides which patients are eligible for treatment.

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