The immune system helps protect the body from illness and cancer. T-cells are an important part of the immune system. They can find and destroy abnormal cells, including some cancer cells. But cancer can sometimes hide from the immune system. Chimeric antigen receptor (CAR) T-cell therapy trains the immune system to attack some types of cancer.
Understanding T-cells
Your immune system is made of many different cells and organs. Its role is to protect you from infection. Your immune system looks for invaders, including cancer. It does this by tracking proteins called antigens on the surface of invading cells.
T cells are a type of white blood cell in your immune system, they:
- Help protect you from infection
- Have their own surface protein called receptors
- Can recognise cells that have abnormal antigens
- Can destroy abnormal cells
How does CAR T-cell therapy work?
Chimeric antigen receptor (CAR) T-cell therapy is a type of immunotherapy. It is sometimes referred to as a CAR-T cell transplant.
- T-cells are collected from you through a process called apheresis
- The T-cells are sent to the lab where genetic information is added to them as well as chimeric antigen receptors (CARs)
- The T-cells are tailor made to recognise your cancer
- The CAR T-cells are grown and multiplied until there are millions of them
- You will be given chemo to prepare your body to receive the CAR T-cells
- The CAR T-cells are infused via an intravenous (IV) drip
- The CAR T-cells recognise, attack and kill the cancer cells
- The CAR T-cells stay in the body for a time and can remain reactive. This can vary from person to person.
Receiving CAR T-cell therapy is a complicated and long process. It is important to discuss the process with your haematologist and ask any questions you have.
Blood cancer and CAR T-cell therapy
Blood cancers that are currently approved for CAR T-cell therapy in Australia include:
- Relapsed or refractory diffuse large B cell Lymphoma (DLCBL)
- Relapsed or refractory mantle cell lymphoma (MCL)
- Relapsed or refractory B-cell acute lymphoblastic leukaemia (B-ALL) in adults and children
- Myeloma
Not all blood cancers are approved for treatment with CAR T-cell therapy in Australia. Clinical trials are also available. If you feel this is an option for you, please discuss it with your haematologist.
Types of CAR T-cell therapy
There are multiple CAR T-cell products that have been approved for use by the Therapeutic Goods Administration (TGA):
| Kymriah® (tisagenlecleucel) Paediatric and adolescent ALL Adult relapsed or refractory DLBCL | Yescarta® (axicabtagene ciloleucel) Adult relapsed or refractory DLBCL |
| Tecartus® (brexucabtagene autoleucel) Relapsed or refractory MCL Relapsed or refractory B-ALL | Carvykti® (ciltacabtagene autoleucel) Relapsed or refractory myeloma |
CAR T-cell therapy side effects
CAR-T cell therapy can have many side effects. Part of the process of CAR T-cell therapy involves receiving chemo. You are likely to experience chemo side effects as well as some more serious side effects. These side effects include:
Cytokine release syndrome (CRS)
As CAR T-cells grow, they can release chemicals called cytokines into the blood. This can make the immune system very active and cause serious side effects, such as:
- High fever and chills
- Trouble breathing
- Severe nausea, vomiting, and/or diarrhea
- Feeling dizzy or lightheaded
- Headaches
- Fast heartbeat
- Feeling very tired
- Muscle and/or joint pain
Immune effector cell-associated neurotoxicity syndrome (ICANS)
CAR T-cells can affect the nervous system and cause neurological problems. These side effects are called immune effector-cell associated neurotoxicity syndrome (ICANS), or neurotoxicity. These are some of the symptoms of ICANS:
- Headaches
- Changes in consciousness
- Confusion or agitation
- Seizures
- Shaking or twitching (tremors)
- Trouble speaking and understanding
- Loss of balance
These side effects are serious and require urgent medical attention. There are some precautions you will need to take while receiving CAR T-cell therapy. These include:
- Stay close to the hospital if you live regionally – accommodation can be arranged through a social worker at your treatment centre or at Accommodation services – Leukaemia Foundation
- Have a support person stay with you
- Do not drive for at least 8 weeks after having CAR T-cell therapy
- Follow the instructions from your treatment team
For information on chemo side effects, please visit Chemotherapy – Leukaemia Foundation
CAR T-cell therapy and clinical trials
Researchers continue to look for new uses of CAR T-cell therapy in clinical trials. It is best to talk with your treatment team about accessing clinical trials. They will have access to the most up to date information on available trials. You can search for clinical trials at Clin Trial Refer.
Where is CAR T-cell therapy available in Australia?
Victoria
- Alfred Health CAR-T Cell Therapy
- CAR T-Cell therapy – Peter MacCallum Cancer Centre
- The Royal Children’s Hospital
New South Wales
Queensland
- Royal Brisbane and Women’s Hospital
- Princess Alexandra Hospital
- Townsville Hospital and Health Service
Western Australia
Some hospitals not mentioned above might offer CAR T-cell therapy through clinical trials. Check with your treatment team to see if this is available at a location near you.
More information
References
- Associate Professor Paul Beavis receives Cancer Council Victoria Venture Grant to develop CAR T-cell therapy for solid tumours – Peter MacCallum Cancer Centre
- Treatment fact sheet template
- CAR T-cell therapy now available at Princess Alexandra Hospital, Brisbane
- CAR T-cell Therapy and Its Side Effects | American Cancer Society
- CAR T Cells and T-Cell Therapies for Cancer: A Translational Science Review – PMC
- Cell therapies – Peter MacCallum Cancer Centre
- Standard of Care in CAR T-Cell Therapy – Peter MacCallum Cancer Centre
- YESCARTA® (axicabtagene ciloleucel) Patient & Caregiver Site | CAR T-Cell Therapy for Certain Types of Non-Hodgkin Lymphoma in Adults
