Addenbrooke’s Hospital in Cambridge becomes first in region to offer revolutionary CAR-T cell therapy for cancer patients
Cutting-edge CAR-T cell therapy is now on offer for some cancer patients at Addenbrooke’s Hospital.
It has become the first hospital in the East of England to offer the treatment.
Cambridge University Hospitals (CUH) said it puts Addenbrooke’s into the premier league of world class cancer centres.
The first patients to be approved for the therapy began their treatment this month. It is being offered initially to patients with aggressive B-cell lymphomas and acute lymphoblastic leukaemia (ALL) who have relapsed or not responded well to chemotherapy or stem cell treatment.
CUH said it was “likely” in future to be offered to cancer patients aged over 70 who are considered to be too high risk to have stem cell transplants.
About 40 patients a year are expected to benefit initially, but the treatment is ultimately expected to be expanded to include patients with other cancers.
The therapy can have risks, and may cause unpleasant side effects, but it has shown remarkable results, even curing some patients with advanced cancers or those for whom other treatment options have failed.
CAR-T - chimeric antigen receptor T-cell - therapy involves reprogramming a patient’s own immune system cells to target their cancer.
T-cells, or T lymphocytes, are a key line of defence in our immune system. Circulating in our bloodstream, their roles include killing infected cells and activating other immune cells.
Cancer cells sometimes evade their attention because they evolve from our own cells.
The process involves harvesting a patient’s own T-cells. These are sent to a laboratory for reprogramming so that they express a molecule on their surface called a chimeric antigen receptor, or CAR, that targets them to the cancer.
Huge numbers of these reprogrammed cells are grown over a few weeks in the lab, then infused back into the patient’s body to be unleashed on the cancer.
Ben Uttenthal, consultant haematologist specialising in CAR-T cell therapy at Addenbrooke’s, said: “This is an exciting new way of treating patients that attacks cancer in a different way from previously available medicines.
“It is also a testament to the expertise available across many different specialties in Addenbrooke’s.
“Through offering treatments like this, now and in the new Cambridge Cancer Research Hospital, we will be able to benefit cancer patients locally, regionally and nationally.”
It is typically initially effective in up to 85 per cent of patients, with 40-50 per cent of patients having a long-term response in lymphoma.
But it is expensive - Gilead Science’s axicabtagene-ciloleucel, also known as Yescarta, for adult patients with large cell lymphoma, would cost nearly £300,000 at its full list price, but a reduced price was agreed in 2018 enabling it to be offered on the NHS.
Similarly, the list price for Novartis’ Tisagenlecleucel, also known as Kymriah, which is used to treat relapsed or refractory diffuse large B-cell lymphoma, is £282,000, although the company agreed a discounted undisclosed price when it was approved by NICE for use in the NHS from 2019.
The first NHS hospital to use a CAR-T therapy in the UK was King’s College London.
Before Addenbrooke’s joined the list, seven NHS hospitals were able to offer CAR-T for adults with large B-cell lymphoma, while nine offered CAR-T for acute lymphoblastic leukaemia for children and young people up to the age of 25.
CUH told the Cambridge Independent it underwent a rigorous inspection and accreditation by international organisation JACIE and further inspections from the manufacturers of the therapies and by NHS England.
A new consultant, junior doctors, new pharmacists and new specialist nurses have been recruited and extensive training given to staff to handle the products and help manage potential side effects.
Side effects can include cytokine release syndrome, which causes a fever, dizziness due to low blood pressure and difficulty breathing, although there is a therapy available to combat it.
In some cases, CAR-T therapy can impact the brain, causing headaches and altered consciousness, leaving patients confused or disoriented, suffering speech changes or seizures, which may require steroids to counteract.
In treatment for some leukaemias, the therapy can also kill normal B cells as well as cancerous B cells, which can make it difficult to fight infections. Immunoglobulin therapy can be given in response.
The treatment offer comes as plans continue to be developed for Cambridge Cancer Research Hospital beside Addenbrooke’s.
As the Cambridge Independent reported, the government included £120million towards the new hospital in the second wave of its hospital infrastructure programme (HIP2) in October.
‘It saved my life’
Leukaemia patient Steve Johnson credits CAR-T cell therapy with saving his life.
Steve, from Bourne in Lincolnshire, underwent the treatment for relapsed leukaemia at the University College Hospital in London as part of a clinical trial.
He said: “Having the treatment is not pleasant – I had a number of fevers and temperature spikes for two weeks after the CAR-T cells were put back in, but I have absolutely no doubt this treatment saved my life and without it I would not be here today.
“I was lucky – for me the trial came at the right time. Having the option to explore and provide revolutionary treatments at places like Addenbrooke’s and the soon to be built Cambridge Cancer Research Hospital is vital if we are going to rewrite the story of this devastating illness.”
Until now, patients like Steve in the East of England who needed CAR-T therapy have had to make frequent trips to London in preparation for the treatment, which can take another month to administer.
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