UK treats first patients with CAR T therapy

Mallinckrodt & Silence Therapeutics to develop RNAi therapeutics
Credit: Shutterstock.com/ Syda Productions

The first adult patients in the UK have been treated with the newly approved CAR T therapy at King’s College Hospital in South London.

Currently, CAR T therapy is being used on selected patients at King’s with a recurrence of lymphoma – a cancer that begins in the infection-fighting cells of the immune system.

These cells are found in the lymph nodes, spleen, thymus, bone marrow, and other parts of the body.

Dr Reuben Benjamin, Consultant Haematologist at King’s, who led the clinical trial that delivered the first CAR T cell therapy at King’s.

He said the CAR T trial “has been shown in trials to cure some patients, even those with advanced cancers, when other treatments have failed”.

The treatment is effective in around 40-50% of cases, including patients who did not respond well to chemotherapy, but has a unique set of side effects, including neurotoxicity, in the short-term.

Dr Benjamin added: “Patients who receive the treatment can experience a range of unpleasant side effects from high fever; vomiting; and diarrhoea to confusion; aphasia (difficulty understanding or speaking); and loss of consciousness.”

King’s has been at the forefront of this therapy by bringing together researchers and clinicians as part of King’s Health Partners, turning the latest research into pioneering new treatments for patients.

As a result of this partnership, all CAR T patients are screened for anxiety and depression. Any patient showing symptoms will receive mental health support to cope with the difficult effects of the treatment.

This makes King’s unique as no other UK hospital offering CAR T therapy joins up physical and mental health treatment in this way.

One of the first patients to receive the treatment was 62-year-old Mike Simpson, a solicitor from Durham.

The married father-of-two was diagnosed with stage 4a Diffuse Large B-Cell Lymphoma, a fast-growing form of blood cancer, in 2015 after discovering a lump in his neck. He underwent chemotherapy and radiotherapy at his local hospital and went into remission.

Ten months later, he relapsed and was treated again. After going into remission for a second time, the cancer returned.

He came to King’s in late 2018 for pre-assessment and had his cells harvested in early January 2019. While they were sent to the USA for modification, Mike was given ‘holding’ treatment to ensure his lymphoma remained under control as this process takes four weeks. Once the CAR T cells were manufactured, he was given conditioning chemotherapy to prepare for the infusion of modified T cells, which he received in February.

Mike said: “It was no walk in the park. I spent almost a week in intensive care and when I was well enough to be moved back to the ward I had to re-learn basic tasks such as climbing stairs. I was fortunate to have the support of my wife and children, who had to watch me go through the changes hoping all the time they would be temporary.”

Despite the initial adverse reaction to the therapy, Mike has responded well to the treatment and is working towards remission. He is back at home, spending time with his young grandchildren and regaining his strength.

Mike is hopeful for the future, including a return to work, but recognises how lucky he is. “I’m incredibly grateful for being given the opportunity to have this therapy as I know it’s a costly, one-time treatment. I describe it as my L’Oreal treatment… because I’m worth it,” he joked.

Dr Victoria Potter, Consultant Haematologist and Director of Stem Cell Transplantation at King’s, said, “In cases such as Mike`s, CAR T therapy is a last resort when other treatments have failed.

“Although it does not work for everyone, from what we have observed in clinical trials this type of personalised medicine offers real hope for lymphoma patients who otherwise would have limited options. We are very hopeful this treatment will be a game-changer for our patients.”

The NHS is providing CAR T therapies for children and young people with B cell acute lymphoblastic leukaemia, and adults with diffuse large B-cell lymphoma and primary mediastinal B-cell lymphoma in England.