In Ottawa, doctors could only offer Dupont palliative care. But her hematologist, Dr. Jill Fulcher, and a colleague, Dr. Natasha Kekre, a scientist at The Ottawa Hospital, knew of clinical trials in the United States where a novel cancer treatment known as CAR-T therapy was producing some remarkable results. They helped enrol Dupont in one of the trials.
First tested on leukemia patients in 2010, CAR-T therapy is designed to unleash the power of the immune system’s T cells against cancer.
The treatment is at the leading edge of molecular biology and medical technology. As part of the therapy, a patient’s T cells — white blood cells that guard against foreign invaders — are genetically engineered to recognize and attack cancer cells, an internal threat. Those cells, altered with the help of a virus, are multiplied in a lab and infused by the millions back into a patient.
The Children’s Hospital of Philadelphia was the site of some pioneering work in the field of CAR-T therapy. Researchers there were part of a landmark study published in the New England Journal of Medicine in October 2014: It reported that 27 out of 30 young patients with advanced acute lymphoblastic leukemia had responded to CAR-T therapy and gone into remission.
Kekre wanted to know if Canadian scientists could manufacture their own CAR-T cells to jumpstart research and launch clinical trials in this country. Bell says the question galvanized the group: “When we sat down, we said, ‘This is just craziness. We know how to do this. Why aren’t we sharing our resources to do it?’”
The problem was that none of the researchers focused exclusively on CAR-T cells; they all had established labs funded for other projects. CAR-T therapy was a different ball game.
The scientists and their labs brought different strengths. Ottawa had the ability to manufacture the virus required to deliver genetic material to a patient’s T cells; Vancouver could make the genetic material to be inserted into T cells; while Victoria had the expertise and infrastructure to manufacture the modified CAR-T cells.
The researchers collaborated on a 2,000-page funding proposal, but there were a series of hurdles to overcome. The scientists had to figure out how to co-ordinate their activity, how to deliver CAR-T clinical trials across the country and how to convince government officials the treatment was a justifiable expense inside the country’s cash-strapped public health-care system.
CAR-T is at the vanguard of the immunotherapy revolution, an approach that leverages the power of the immune system to destroy cancerous cells. The immune system does not easily recognize cancer as something to be destroyed because it’s not an invader: Cancer evolves from defective cells already inside the body. Cancerous cells also go through genetic changes to help them escape detection by T cells.
CAR-T therapy re-engineers T cells so they can find and attack cancer. An inactive virus is used to insert genes into a patient’s T-cells to create artificial receptors — chimeric antigen receptors (CARs) — on the surface of the cells. Those receptors equip T cells with the ability to recognize a protein on the surface of tumour cells and to launch a chemical attack against them.
The designer T cells infused during CAR-T therapy can stay on patrol in a patient for years to guard against a cancer’s return.
They have so far protected Stefany Dupont. Now 26, Dupont has been in remission since her CAR-T therapy in Philadelphia four years ago. She works for an international development organization in Montreal, Development and Peace.
She believes CAR-T and other immunotherapies hold immense potential, and she hopes they will one day replace chemotherapy and radiation as standard cancer treatments.
“Eventually, we should turn away from chemotherapy and radiation,” she says. “They work, but they’re very hard on your body. I don’t really know what my life expectancy is, but a lot of problems can come up later because of what I was exposed to.”
Dupont remains immensely grateful to doctors in Ottawa and Philadelphia for saving her life. She tries hard, she says, to be “normal” despite the psychological and physical challenges she faces.
“It’s always going to be there and it affects me every day: My energy isn’t as high as other people. I have to be patient with myself a lot, take a lot naps and stuff like that. But, apart from that, I’m able to lead quite a normal life.”
This content was originally published here.