CAR Pool: Immunotherapies Improving Outcomes in ALL

For adults with acute leukemia, CAR T cell immunotherapies, targeted drugs and pediatric chemotherapy regimens are improving outcomes.
When a disease is incurable in 60 percent of the adults who develop it, the idea of a new treatment that can spark complete remissions in the majority of those affected seems tantalizing.

Based on recent testing of a promising immunotherapy technique in patients with relapsed acute lymphoblastic leukemia (ALL), the idea also seems like a real possibility.

Hope was inspired after the treatment — part of a new class known as chimeric antigen receptor (CAR) T cell therapies — was tested in youngsters with ALL. In late 2014, researchers announced that the one-time treatment, called CTL019, produced full remissions in 92 percent of children with relapsed ALL in an early clinical trial. The oncology community was understandably ebullient. The treatment involves removing T cells from each patient’s immune system, inserting a gene sequence into the T cells that prepares them to home in on and destroy cancer cells, and then infusing them back into the patients, where they not only do that work, but multiply. Although it’s too early to say what the long-term survival rate will be, the data suggests that the engineered cells continue to keep cancer at bay for upwards of two years.

Now, two other CAR T treatments — JCAR015 and KTE-C19 — have demonstrated remarkable response rates in relapsed/refractory ALL, and adults are among the patients enjoying those outcomes. The treatments work by targeting the protein CD19, which is commonly found on the surface of ALL cells. Full remission rates range from 70 to 90 percent in childhood and adult ALL patients; larger phase 2 trials with CD19 CAR Ts are under way.

CAR T is one of several experimental treatments for adults with leukemia that centers around using patients’ immune systems to beat cancer — a growing area, known as immunooncology, that has engendered tremendous optimism among patients and their oncologists.

New strategies are sorely needed in ALL and AML, which, especially in adults, can be marked by treatment followed by periods of remission — and then recurrence.

ALL will strike more than 6,200 Americans in 2015, 60 percent of them children, according to the American Cancer Society. But while the condition is highly curable with chemotherapy in kids, four out of five deaths from the disease occur in adults; among adults with the condition, the survival rate is around 40 percent.

There is also a second major type of acute blood cancer that affects adults — in fact, almost exclusively adults: The American Cancer Society estimates that there will be about 21,000 new cases of acute myeloid leukemia (AML) in 2015, with the average patient being diagnosed at age 67. With current chemotherapy strategies, two-thirds of patients achieve remission, but the five-year survival rate is only about 25 percent, with patients over 60 faring less well than younger adults.

Better results in both diseases are hovering on the horizon, studies of new treatments suggest.

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