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Food and Drug Administration (FDA) approval of Kymriah

 (tisagenlecleucel) for the treatment of certain children and young adults with acute lymphoblastic leukemia, marking the first FDA-approved CAR-T cell therapy for patients with cancer.

Over the past half decade, six CAR-T cell drugs gained FDA approval for various types of leukemias, lymphomas and multiple myeloma, drastically changing the treatment paradigm of patients with blood cancer.

CAR-T cell therapy uses a patients’ own immune system to attack the cancer.

“In CAR-T cell therapy, the ‘CAR’ means chimeric antigen receptor,” 

Dr. Jordan Gauthier of Fred Hutchinson Cancer Center

 in Seattle said in an interview with CURE®. “We use one white blood cell type we call T cells and, we engineer them in the lab to express this new receptor that we call CAR … so we ‘cook’ the cells in the lab until we have enough of them, and then we put them in a bag and infuse them.”

Of note, Gauthier was a member of the Seattle Cancer Care Alliance at the time of the interview. In April, the Seattle Cancer Care Alliance and Fred Hutchinson Research Center united to become one organization known as the Fred Hutchinson Cancer Center.

The CAR-T cell therapy process starts with a blood draw so that clinicians can collect the patients’ white blood cells. The T cells will then be specially engineered to find and attack cancer. Once the killer T cells are made, they will be multiplied.

While T cells are being created, the patient will undergo conditioning chemotherapy treatment, which will kill off other immune cells, essentially “making room” for the engineered T cells to proliferate within the body.

Once the T cells are engineered and the patient has finished conditioning treatment — a process that typically takes a couple of weeks — the CAR-T cells will be infused back into the patient.

At this point, patients and their health care team must 

, namely neurotoxicity (impairment to brain function) and cytokine release syndrome (the release of too many inflammatory molecules into the blood) — both of which could be serious if not caught early.

While prior studies have shown that the majority of patients undergoing CAR-T cell therapy will experience side effects, ongoing research is trying to determine which patients are 

After patients leave the hospital after the side effect monitoring period is over, they may not need to return for more treatment, as CAR-T cell therapy often offers patients a 

 with lasting efficacy and cancer control, explained Dr. Lori A. Leslie, director of the Indolent Lymphoma and CLL Research Program at John Theurer Cancer Center in Hackensack, New Jersey.

 may qualify for CAR-T cell therapy, researchers are still studying 

, as well as investigating CAR-T cell therapy’s potential in different cancer types — 

Additionally, this summer, the FDA agreed to speed up their review of a 

 to treat rare forms of lymphoma and leukemia.

“We've started to see some patients with very long-term remissions now from CAR T. So I'm excited to see the how that field evolves in the coming years,” 

said Dr. Matthew Davids, of the Dana-Farber Cancer Institute

 in Boston, in an interview with CURE®. “I'm excited to see the how that field evolves in the coming years.”

For more news on cancer updates, research and education, don’t forget to 

Over the past five years, CAR-T cell therapy has improved outcomes for many patients with blood cancer. Here’s what patients need to know about the immune-based treatment.

What Is CAR-T Cell Therapy, and What Can Patients With Cancer Expect?

Myeloma: Diagnosis

Doctors who suspect myeloma will conduct a series of blood and urine tests to check blood counts and kidney function in addition to protein, calcium and antibody levels. If these numbers suggest that myeloma is present, doctors will take a bone marrow biopsy. This can be done by inserting a needle into the back of the pelvic bone and taking out a core — approximately the size of the tip of a lead pencil— that contains a small amount of marrow. This allows a pathologist to look for myeloma cells.

An X-ray, MRI, CT or positron emission tomography scan can sometimes show bone changes or destruction caused by myeloma.

An echocardiogram might be used to check heart function, which can be affected by myeloma.

To diagnose myeloma, a doctor must find malignant plasma cells or 10% plasma cells in the bone marrow and at least one of the following: high blood calcium level, poor kidney function, anemia, holes or lesions in the bones, a specific level of increase in one type of light chain antibody fragment in the blood, or 60% or more plasma cells in the bone marrow.

Myeloma is classified in stages 1 through 3, with 3 having spread the farthest and representing the highest risk. Additional genetic and chromosomal testing can help determine treatment.

Diet & Exercise

Diagnosis

Bladder Cancer: Overview

Bladder cancer is also known as urothelial carcinoma. Urothelial cells line the urinary tract, including the urethra, bladder, and ureters and renal pelvis in the kidneys. These urothelial or transitional cells are in contact with urine. Bladder cancer happens when those cells in the bladder start to grow out of control.

Smoking and being exposed to secondhand smoke increases the risk of developing bladder cancer. In addition, people exposed to occupational or environmental chemicals may have a higher risk of developing bladder cancer. White people are twice as likely to develop bladder cancer as are Black people or Hispanic people, and older age is another risk factor. Health history also matters, with chronic bladder inflammation, such as urinary tract infections or kidney stones, as well as a personal or family history of bladder cancer, associated with risk of the disease.

Many people are unaware of the common signs of bladder cancer, such as blood in the urine, known as hematuria. If blood in the urine can be seen, this is called gross hematuria. When a physician runs a urinalysis test as part of a routine checkup, tiny amounts of blood may be detected. This is microscopic hematuria. Any blood seen in the urine should be checked by a physician. Irritation when urinating, urgency and frequency are other warning signs. These signs may also be from other causes, such as a urinary tract infection, kidney stones or aging.

Bladder Cancer: Living with Cancer

Bladder cancer has a high rate of recurrence, which implies the need for regular surveillance with cystoscopy over the course of a patient’s lifetime. For some patients, the new normal after bladder removal surgery is adjusting to life with a urinary diversion. A patient should always feel comfortable talking with their health care team about any issues or questions. If the team can’t help, they can usually find someone who can.

Bladder Cancer: Types of Disease

Doctors usually describe and treat bladder cancer by how far it has grown into the bladder wall.

NMIBC (non-muscle invasive bladder cancer) is cancer that remains in the urothelial cells that line the bladder.

MIBC (muscle-invasive bladder cancer) is cancer that has grown into the deeper layers of bladder muscle.

If bladder cancer has spread to other parts of the body outside the urinary tract, it is advanced disease, or metastatic.

Types of bladder cancer include urothelial carcinoma, squamous cell carcinoma, adenocarcinoma, small cell carcinoma and sarcoma.

Urothelial carcinoma, the most common type of bladder cancer, is also known as transitional cell carcinoma. Transitional cell carcinoma begins in the part of the kidney, called the renal pelvis, where urine collects before moving to the bladder.

Squamous cell carcinoma comprises 1% to 2% of bladder cancers, according to the American Cancer Society. Most squamous cell carcinomas of the bladder are invasive.

Adenocarcinoma, which are also mostly invasive, occur in only 1% of bladder cancers.

Small cell carcinoma, which occurs in less than 1% of bladder cancers, start in the neuroendocrine cells. This subtype of the disease can grow quickly.

Sarcoma of the bladder is rare, and start in the muscle cells of the organ.

Bladder Cancer: Diagnosis

A urologist will make a bladder cancer diagnosis. Urologists use a cystoscope to examine the lining of the bladder and the tube that carries urine out of the body (urethra).

If bladder cancer is diagnosed, the doctor needs to know the stage, or extent, of the disease to plan the best treatment. Staging is a careful attempt to find out whether the cancer has invaded the bladder wall or spread beyond that, and, if so, to what parts of the body. Grade refers to how abnormal the cancer cells look and how many cells are multiplying. A higher grade means the cells are more uneven and are multiplying more. Knowing the grade can help your doctor predict how quickly the cancer will grow and spread.

Bladder Cancer: Treatment

When bladder cancer is classified as NMIBC, surgery to remove the tumor is often the first step. A transurethral resection of the bladder tumor uses a special instrument inserted through the urethra to remove the tumor. If the tumor is low risk/grade and has not invaded the muscle wall of the bladder, it may not require more treatment. Unfortunately, bladder cancer has a high rate of recurrence so most of those who receive diagnoses must return to their urologist at regular intervals for surveillance using cystoscopy to see if the tumors return.

If the tumor cells appear aggressive under the microscope and the pathologist determines that the cancer is high risk/grade, it is more likely to return or worsen. In these cases, further treatment to keep the cancer from returning or worsening is required. Most often, patients with high-grade NMIBC receive intravesical (inside the bladder) treatments. Bacillus Calmette-Guérin (BCG) is an early form of immunotherapy that uses a weakened form of bacteria. When these bacteria are put into the bladder, the immune system goes on alert. It responds by killing cancer cells on the bladder lining. Though BCG is very effective, it doesn’t work for all tumors. If BCG doesn’t work, there are other options such as mitomycin C, an antibiotic that helps fight tumors.

When bladder cancer grows into the deeper layers of the bladder (MIBC), it is more difficult to treat. In many cases, a urologist may suggest radial cystectomy, which is surgery to remove your bladder. Removing the bladder also involves removing lymph nodes around the organ. As part of the surgery, it will be necessary to create a urinary diversion, a new way for urine to leave your body.

Systemic chemotherapy is medicine that treats cancer throughout the whole body. Neoadjuvant chemotherapy is chemotherapy patients get before bladder removal surgery. Clinical trials have shown that cisplatin chemotherapy before bladder removal improves survival for patients with MIBC because it helps kill bladder cancer cells that may be outside the bladder. Adjuvant chemotherapy is the chemotherapy patients get after surgery.

Recently approved targeted therapies can block the growth and spread of cancer. They focus on stopping the cancer-driving activity caused by specific genetic mutations that are found in some bladder cancers.

Some patients may benefit from combined modality therapy, which uses surgery to remove the tumor, plus chemotherapy and radiation to help kill the cancer while keeping the bladder intact. This option can be used for some patients who are ineligible for bladder removal surgery. Those with advanced or metastatic disease may benefit from chemotherapy and a variety of immunotherapies that can help the body fight off the cancer.

There are many talented researchers and clinicians working to improve the diagnosis and treatment of the disease. Clinical trials are an essential part of bladder cancer research. They may provide treatment alternatives to patients who have not had success with standard and approved therapies.

Breast Cancer: Living with Cancer

Similar to other cancers, there is often a fear breast cancer will return, and in some individuals, the cancer will never go away completely. Therefore, it is key to maintain follow-up appointments for physicians to watch closely. These include consistent doctor appointments, mammograms, pelvic exams, bone density tests, as well as we blood and imaging tests.

Survivorship care plans, comprised of a suggested schedule for follow-ups, a list of long-term effects, lifestyle modification suggestions and a summary of ones diagnosis, may be very helpful for long-term care and to aid individuals in transitioning back to a primary care provider.

Breast Cancer: Types of Disease

The type of breast cancer that is diagnosed is determined by specific cells.

Ductal carcinoma in situ, or DCIS, also known as intraductal carcinoma, is when the abnormal cells have not spread through the ducts into surrounding breast tissue. It is a non-invasive breast cancer that has not spread outside of the breast; however, it can become invasive.

Lobular carcinoma in situ, also called lobular neoplasia, is when the abnormal cell growth starts in the lobules of the breast and has likely not spread to surrounding tissues. This subtype can be an indicator for the likeliness of developing invasive cancer in either breast.

Invasive ductal carcinoma, also known as infiltrating ductal carcinoma, is the most common type of breast cancer that occurs when the cancer starts in the ducts of the breast, then grows into fatty breast tissue. This type of breast cancer may spread to other parts of the body.

Invasive lobular carcinoma, also known as infiltrating lobular carcinoma, starts in the lobules of the breast. As one of the less common types, invasive lobular carcinoma may be difficult to detect via mammogram.

Inflammatory breast cancer, an uncommon type of invasive breast cancer, occurs when the cancer cells block the lymph vessels in the skin, causing inflammation, redness, pitted appearance, itchiness or tenderness. In this instance, a lump may not be detected

Paget disease, also rare, starts in the ducts and spreads to the skin of the nipple. Symptoms include crusted, scaly, red, bleeding, oozing, burning or itchy nipples.

Lastly, there are subtypes of breast cancer driven by hormones that will drive treatment decisions: hormone receptor-positive, HER2-positive and triple-negative breast cancer.

Breast Cancer: Diagnosis

After a biopsy or surgery to remove the breast cancer, a pathologist examines the tissue and may run additional tests to create a pathology report to help create an appropriate treatment plan for the patient. In addition, the use of an Oncotype Dx® Recurrence Score results may also be considered and used to determine certain treatment.

Stage 0, carcinoma in situ, is the earliest stage of breast cancer, followed by:

Stage 1: The tumor is 2 centimeters or smaller; the cancer has not spread outside of the organ; or small clusters of cancer cells are found in the lymph nodes.

Stage 2: There is no tumor, or the tumor is smaller than 2 centimeters, but the cancer is also found in the lymph nodes or the breast; or the tumor is larger than 2 to 5 centimeters, but the cancer has not spread to lymph nodes.

Stage 3: There is no tumor, or the tumor can be any size, but the cancer has spread to the lymph nodes; the tumor is larger than 5 centimeters and small clusters of cancer cells are found in the lymph nodes or the breast; or the tumor is larger than 5 centimeters and the cancer has spread to the lymph nodes.

Stage 4: The cancer has spread to other parts of the body, often in the bones, lungs, brain or liver.

When determining the stage of breast cancer, key pieces of information include the size of the tumor, its spread to nearby lymph nodes, metastasis to other parts of the body, grade of the cancer, as well as estrogen receptor, progesterone receptor and HER2 status.

Breast Cancer: Overview

Breast cancer, which occurs when cells grow out of control, can start in one or both breasts, in different parts of the organ – lobules, ducts, nipple, fat and connective tissue, blood vessels and lymph vessels.

Although most common in women, men can get breast cancer, too

Signs of breast cancer can include a lump in the breast or arm pit, a change in shape or size of the breast, nipple changes or discharge, and skin changes to the breast.

Risk factors for breast cancer include binge drinking, being overweight, especially after menopause, living a sedentary lifestyle and an unhealthy diet, which are all changeable lifestyle factors. In addition, unchangeable risk factors include female gender, older age, genetics, family history of the disease, personal history of the disease, race and ethnicity, dense breasts, benign breast conditions, exposure to diethylstilbestrol, menstruation, menopause, previous chest radiation and recurrent breast cancer.

Screening for breast cancer includes breast self-exams, clinical breast exams by health care providers and mammograms.

Although breast cancer can be confined to the breasts, it is possible for the cancer cells to invade the bloodstream or lymph system, traveling to other parts of the body, causing spread, or metastasis.

Myeloma

DIAGNOSIS

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