CAR-T

The immune system detects cells that it doesn’t recognise by finding proteins called antigens on the surface of those cells. T cells are immune system cells that have their own proteins called receptors that attach to foreign antigens. This helps trigger other parts of the immune system to destroy the foreign invader.

Cancer cells also have antigens, but if the immune cells don’t have the right receptors they can’t attach to the antigens and help destroy the cancer cells.

CAR-T is Chimeric Antigen Receptor T-cell therapy. T-cells are taken from the patient’s blood and then modified in the laboratory by adding a gene for a receptor (called a chimeric antigen receptor) which helps the T-cells attach to a cancer cell antigen, with each CAR being made for a specific type of cancer. The CAR-T cells are then returned to the patient so they can find and destroy the cancer cells.

CAR-T is used to treat follicular lymphoma in the USA (it was approved in 2022) and it is licensed in the UK for relapsed follicular but it is not currently easily available through the NHS. Though it is used by the NHS for three lymphomas; diffuse large B-cell, mediastinal large B-cell and mantle cell.

It’s all down to cost. The personalisation aspect of the treatment, collecting and modifying the patient’s T cells, makes it expensive. This is why there is increasing excitement about Bispecifics, it is a similar approach but without needing the personalisation.

There will no doubt be a role for both in future and what is extremely exciting from a patient’s viewpoint is that there are two very promising new treatments getting really good results. The pace of development means they will go from strength to strength and that gives me huge cause for optimism.

The challenge now is to get the NHS to use CAR-T as a standard treatment for follicular lymphoma.