As CAR T-cell therapy continues to evolve as a novel treatment for various types of cancers, an awareness of both its promise and potential toxicities is important for physicians of all specialties.
Formally known as chimeric antigen receptor T cell therapy, this treatment uses laboratory-engineered T cells to target specific proteins on cancer cells. The process requires removing T cells from a patient’s blood, reprogramming them and infusing them back into the body to bind to cancer cells and kill them without damaging healthy cells.
Currently, CAR T-cell therapy is FDA-approved for diffuse large B-cell lymphoma, follicular lymphoma, mantle cell lymphoma, multiple myeloma, and B-cell acute lymphoblastic leukemia (ALL) for adults and children.
One remarkable aspect of this form of immunotherapy is that when successful, it can lead to long-lasting remissions, even in patients with very advanced disease. In most of the cancers cited above, the complete response rate for indicated patients is 40 to 50 percent with T-cell infusions, compared to less than 10 percent without them.
Additionally, clinical trials are ongoing to judge CAR T’s efficacy in treating multiple solid malignancies, including neuroblastoma and other brain cancers, ovarian and breast cancer. Several of those trials should be available to local patients in the fall.
While not enough data has yet been collected to predict benefits, early results have been promising. Therefore, the expansion of CAR T-cell therapy and products seems certain to occur in the near future, nationally and at more practices in Hampton Roads.
Furthermore, CAR T-cell therapy is moving up the treatment algorithm for liquid tumors. In many cases, medical oncologists now offer it earlier in a patient’s treatment course, no longer considering it a last resort after chemotherapy and radiation have failed.
All that said, CAR T-cell therapy can put patients at higher risk for serious short and long-term health issues. Therefore, physicians outside oncology practices will be tasked with diagnosing and treating complications in patients seen on hospital rounds or in office settings.
Producing an anti-cancer immune reaction can trigger a systemic inflammatory response, most commonly cytokine release syndrome (CRS). The severity and length of CRS can vary widely, with side effects ranging from mild flu-like symptoms to multiorgan failure.
Adverse cardiovascular events may include sinus tachycardia, hypotension, arrhythmias and reduced ejection fractions. Neurologic symptoms such as confusion, tremors, speech problems, seizures and even coma also can occur in CAR T-cell patients, as can bacterial, viral and fungal infections linked to immunosuppression.
Although researchers are working to remodel the CAR T-cell process to reduce such complications, providers should be prepared to recognize them and collaborate with a patient’s oncology team as needed.
Together, we can give patients the greatest chance of a return to health as we embrace this innovative approach to fighting cancer.
Dr. Simmons is a specialist in Medical Oncology, Hematology, and Transplant and Cellular Therapy with Virginia Oncology Associates, based at the Brock Cancer Center in Norfolk, Virginia. For more information, go to virginiacancer.com.
By Gary L. Simmons, DO, MSHA
Virginia Oncology Associates
Medical Oncology / Hematology, Cellular Therapy
Medical Oncology and Hematology
VCU, Richmond, VA – M.S. in Health Administration
Hartwick College, Oneonta, NY – B.S. in Biochemistry
Medical School – University of New England College of Osteopathic Medicine, Biddeford, ME
Residency and Internship – VCU, Richmond, VA – Internal Medicine
Fellowship – VCU, Richmond, VA – Hematology / Oncology (Chief Fellow)
Dr. Gary Simmons received his medical degree from University of New England College of Osteopathic Medicine, completed his residency in Internal Medicine as well as his subspecialty training in Hematology/Oncology at Virginia Commonwealth University (VCU) in Richmond, Virginia. His clinical interest includes malignant hematology (leukemia, lymphoma, myeloma), stem cell transplant, CAR T-cell, and cellular therapies to treat malignancies.
During his residency and fellowship, he won numerous awards including the Nationally recognized Arnold P. Gold Humanism and Excellence in Teaching in 2011 and again in 2013. He was named Resident of the year in 2012 and won excellence in Teaching in 2013. During residency and fellowship, he received numerous awards for excellence in scholarship, and during his fellowship he was selected as chief fellow.
He joined the Massey Cancer Center Stem Cell Transplant Program at VCU in 2016 and during this time he continued to receive awards for excellence in Teaching and served as a researcher, administrator and clinician in the cellular immunotherapies and transplant department. He was promoted to medical director of the ambulatory clinics in cellular therapy in 2020 and helped established new care delivery models that improved patient safety in quality outcomes in the program. In 2022, he was promoted to associate professor.
He is well known for being a leader in the development and excellence of the CAR T-cell program at VCU. He has extensive experience in CAR T-cell procedures, and the development of this program has been transformational in the lives of patients with cancer. Dr. Simmons continues to be a leader in CAR T-cell therapy performing research, publishing papers, and giving local, regional, and national talks. He co-authored the BMTinfonet CAR T-cell handbook for patients in 2022.
Dr. Simmons as a leader in CAR T-cell research served as a principal investigator on many cellular therapy trials and is an active member of the Multiple Myeloma Cellular Therapy Consortium. He has an extensive publication record of abstracts and papers and has presented his work at American Society of Transplant Cellular Therapy (ASTCT) and American Society of Hematology (2019, 2020). In 2022, he was a part of six abstracts presented at American Society of Hematology (ASH).
He is board certified in internal medicine, hematology and oncology and is an active member of American Society of Hematology (ASH), American Society of Clinical Oncology (ASCO) and American Society of Transplant Cellular Therapy (ASTCT).
Dr. Simmons has seen the transformational opportunity of cellular therapy and is passionate about access to this therapy for all that need it. He matriculated in the master’s in health care administration (MSHA) at Virginia Commonwealth University (VCU) and hopes to use this degree to better the lives of patients with cancer focusing on therapy delivery, safety, and quality outcomes.
In his spare time, he enjoys being a father to his five children and running ultra-marathons. He has completed several 100-mile endurance runs and once ran one hundred miles on a treadmill.
Brock Cancer Center
6251 E. Virginia Beach Blvd., Ste. 200
Norfolk, VA 23502