Will CART-type treatments be usable to treat prostate cancer?

Many of our readers may be aware of what is known as “chimeric antigen receptor T-cell” therapy (often known as CART), and its development by Carl June and colleagues at the University of Pennsylvania over the past few years.

Since 2012, June and his colleagues have been working closely with the biopharmaceutical company Novartis to develop this new technology and actually bring it to market. And as of yesterday the U. S. Food and Drug Administration assigned “breakthrough therapy” status to this new form of treatment, with specific application to the treatment of adults and children with relapsed/refractory acute lymphoblastic leukemia (ALL) — a late-stage form of hematological cancer. This specific form of CART for treatment of late-stage ALL is currently known as CTL019.

CART is a sophisticated form of personalized, immunologic treatment that has very clear potential in hematologic cancers of certain types. What these types of treatment do is that they can actually “re-program” a patient’s own T-cells to target cancerous cells that express specific proteins necessary to cancer growth.

In the data reported so far, June and his colleagues have shown that:

  • 22 children with relapsed/refractory ALL have been treated with CTL019.
    • 19/22 children (86 percent) experienced complete remission (CR).
    • 5/19 children (26 percent) who had such a CR did, however, experience a later relapse.
  • 32 adults with relapsed/refractory ALL have been treated with CTL019.
    • 7/32 adults (22 percent) experienced CR.
    • 8/32 adults (25 percent) responded to treatment but did not demonstrate CRs.

These are remarkable response rates in a heavily pre-treated group of patients. Dr. June has been quoted as saying that:

Our early findings reveal tremendous promise for a desperate group of patients, many of whom have been able to return to their normal lives at school and work after receiving this new, personalized immunotherapy.

So to the key question: Can this form of treatment be applied to men with prostate cancer?

A table on the Wikipedia web site shows the vast range of cancers in which some preliminary studies have been conducted to explore the potential of CART-type therapies: prostate cancer is included on that list. However, we are still at a very early stage in the development and evolution of CART-type treatments, and such treatments are now known to come with significant risk for adverse events (up to and including death). There is a clear need for caution in the application of second- and third-generation forms of CART, and we have a long way to go before we will know if this type of treatment has real benefit in prostate cancer.

The good news is that there is ongoing research and patents are being filed that are relevant to the potential application of this type of therapy in the management of prostate cancer. However, it is probably going to be another couple of years before we begin to have any clear idea whether these therapies can be effective in the management of advanced forms of prostate cancer.

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