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Q: One of the emerging treatments at KU Cancer Center has been the CAR T-cell program. What does the future of the program look like at KU and what does this particular treatment look like for solid mass tumors and other cancers?
A: An immunotherapy advancement called CAR T-cell therapy is one of today’s most exciting developing cancer treatments. Here at the KU Cancer Center, our efforts in CAR T are led by Dr. Joseph McGuirk, whose efforts and answers are reflected in my answers here.
In its early development, CAR T has been used to treat deadly blood cancers like leukemia, lymphoma and multiple myeloma with stunning results. Among patients with these cancers, who once faced a dire prognosis of just months or weeks to live after traditional treatments failed them, we are today seeing complete remission rates of 50-90 percent.
Our early and dramatic success with CAR T in blood cancer treatment immediately caused us to ask, “How can we do more? Can we apply our CAR T experience and use it to treat solid tumors? Can we use it to help people with breast cancer, colon cancer, lung cancer, prostate cancers – the heavy hitters of cancers?” There are many hundreds of thousands more patients with these cancers than with blood cancers.
There is great potential to apply CAR T-cell therapy to treatments for solid tumors. But there are also unique barriers. The molecules on the surface of the tumor cells that we would target also appear on healthy cells. We need to learn how to target and kill the cancer cells without collateral damage.
There is a tremendous volume of exploration among physician scientists today, including at our cancer center. The focus is to discover the minute differences between the tumor cells and healthy cells so the patient’s T cells can be re-engineered to specifically recognize these distinctions, targeting the cancer cells and sparing the healthy cells. Our cancer center has multiple active trials and trials in development to continue to advance CAR T-cell therapy’s applications as treatments for solid tumors.
Q: Not many people are aware of CAR T-cell treatment and how it works. How is KU making people aware of what it is and its availability?
A: We are proud of our leadership in the development of CAR T-cell therapy, but more importantly, want to do everything we can to increase awareness of it so that more patients and referring physicians know about it and can consider and explore this groundbreaking treatment when they need options.
Our awareness efforts include:
In addition, we published an important article in 2017 from our institution describing for other centers around the country how we built the infrastructure and leveraged our stem cell transplant experience and clinical trials experience and brought it all together to become a safe place with the right team to provide these investigational therapies. That article became a resource for many, a blueprint of the right and necessary elements this research and care demand. We believe in collaboration across our field to help more of us do more for more patients and families.
Q: What is the cost of CAR T-cell treatment and when do you feel that genetic cures will be affordable for everybody?
A: The cost of CAR T-cell therapy depends upon the type of cancer, type of CAR T construct (i.e. there are different costs for different manufacturers), the stage of a patient’s cancer and existing co-morbidities. It is also contingent upon the patient being treated on a clinical research trial or receiving an FDA-approved CAR T-cell therapy. Advances in the treatment and reimbursement for novel, state-of-the-art therapies continue to progress, and it is our hope that ultimately all patients with aggressive cancers will have access to these leading-edge therapies.
Q: Is insurance warming up to pay for it?
A: Insurance coverage certainly varies. These are costly therapies. Many in the field are working to educate payors on the necessities and benefits of these therapies in an effort to improve coverage. Our team includes financial counselors who are happy to work with patients and their insurance carriers to determine coverage. We, as a field, also need to work together to bring the costs of these therapies down. Today, coverage for the FDA-approved indications for CAR T-cell therapy has come a very long way and today most commercial insurance covers the cost of CAR T-cell therapy.
Q: Anything else big that we are missing or anything else you would like to talk about?
A: While CAR T-cell therapy is tremendously innovative and gives hope to many who would not otherwise have it, it’s crucial to note that this is complex care and can be a challenging process. Here at the KU Cancer Center, we have the multidisciplinary, comprehensive team, the infrastructure, the standard operating procedures, and deep experience in stem cell transplant that are essential to this care.
We have earned recognition for leadership in the field: accredited by Foundation for the Accreditation of Cellular Therapy (FACT), first in T-cell receptor therapy, first trials conducted here before CAR T-cell therapy became FDA approved, one of nation’s first sites to offer all the FDA-approved CAR T-cell therapies.
We have deep experience running clinical trials and do an impeccable job at this, and we have a culture of education and collaboration. We present our work regularly to our solid tumor colleagues, and they are interested and want to learn how they can get involved. We are truly at the tip of the iceberg in CAR T-cell therapy. It will continue to advance dramatically, and The University of Kansas Cancer Center will be part of that. It is a tremendously exciting time.
I’d also like to mention that we are only one year away from our next application for renewal of our NCI designation. This is a tremendous team effort and we are extraordinarily fortunate to work with many talented people in our community and region to put together this application. Serving the state and the region as your NCI-designated Cancer Center is a critical part of our focus every day.
