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CAR T cells produce high response rates in ALL, but concerns about side effects remain
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Novel research has demonstrated that treating acute lymphoblastic leukemia with chimeric antigen receptor T cells produces effective response rates in various patient populations.
The emergence of this potential treatment option is “exciting,” but there is still more that clinicians and researchers must learn to better utilize the therapy, Ryan D. Cassaday, MD, of Fred Hutchinson Cancer Research Center, the University of Washington School of Medicine and the Seattle Cancer Care Alliance, told HemOnc Today.
“CAR T cells are a very new, and very exciting therapy that – at least in some of the early studies that have been performed – are showing very high response rates in a disease that, historically, are quite low,” he said. “But, there can be some pretty serious side effects that occur with them – particularly some neurologic toxicity, [as well as the development of] cytokine release syndrome which is very akin to an overwhelming infection.”
Patient selection is going to become significantly important as CAR T-cell therapies become more readily available, he said. Physicians will need to identify patients that may not be able to tolerate some of the more serious side effects, and instead recommend different treatment options.
Physicians also have many questions regarding the long-term outcomes in patients with ALL, he said.
“Many of the initial studies that have been reported are talking about toxicity and initial response rates – which is appropriate considering a lot of these are phase 1 studies,” he said. “But, as some of these patients are followed, What happens to them long-term?, How many patients relapse?, How durable are the remissions?, What do we do after this?”
Future studies should determine if it is best to continue monitoring patients for relapse, to send patients for an allogeneic transplantation, or to consider subsequent infusions of CAR T cells.
The use of CAR T cells in the front-line setting – and their ability to improve long-term rates of remission – remains to be seen. These agents may be most effective for patients who have relapsed, according to Cassaday.
“There’s going to be a lot of unanswered questions that we’re going to have to deal with over the coming years as we learn more about how this therapy works,” he said. – by Ryan McDonald
Disclosure: Cassaday reports no relevant financial disclosures.