Dr. John Kuruvilla
Hematologist, Medical Oncology & Hematology, Princess Margaret Cancer Centre
Chief Innovation Officer, The Cancer Collaborative
For people with certain types of lymphoma, there’s hope with access to emerging immunotherapies.
Chimeric antigen receptor (CAR) T-cell therapy is an emerging immunotherapy used to treat patients with relapsed or unresponsive forms of lymphomas. It involves removing T-cells from the patient’s body, genetically modifying them in a lab to target specific cancer cell markers, and then infusing the modified cells back into the patient’s body. “It’s more targeted than chemotherapy in that it kills only the cancer cells,” says Dr. John Kuruvilla, a hematologist in the division of Medical Oncology & Hematology at Princess Margaret Cancer Centre in Toronto.
There’s a lot of excitement around CAR T-cells because it’s an opportunity to treat patients that wasn’t available before.
Giving lymphoma patients a better chance
For people with certain types of lymphomas, CAR T-cell therapy is becoming an important option for patients who have had at least two lines of prior treatment and the disease has returned or failed to respond. “Whereas this group of patients might not have had an option five years ago, we can now offer them a chance with an effective treatment,” says Dr. Kuruvilla.
Given its demonstrated efficacy with certain types of lymphoma, researchers are also looking at how CAR T-cell therapy might work with other types of cancers. “There’s a lot of excitement around CAR T-cells because it’s an opportunity to treat patients that wasn’t available before,” says Dr. Kuruvilla. There are currently several clinical trials underway that are evaluating the impact of CAR T-cell therapy for other indications.
Access can be a challenge
Access to CAR T-cell therapy is currently a bit of a challenge in Canada. Being a new and expensive treatment, CAR T-cell therapy is currently only given to lymphoma patients who have exhausted two or more lines of treatment. “The data that led to the approval of CAR T-cell therapy was in specific patients who have had standard treatments that haven’t worked,” says Dr. Kuruvilla.
Another access challenge is geography. “When we think about every Canadian having access to commercially available CAR T-cell therapy, no matter where they live, the answer is no,” says Sabrina Hanna, Chief Innovation Officer at The Cancer Collaborative, a Montreal-based hub that advocates for action-oriented changes in cancer care delivery. There are currently CAR T-cell therapy treatment centres in Quebec, Ontario, and Alberta, and one was recently announced for Nova Scotia. “So, when I think of patients in BC, they’re sending their patients across the border to the U.S. or out of province, which means they have substantial out-of-pocket costs. The follow-up care is not the same as it would be if they were being treated close to home, and obviously with COVID-19 that’s a huge issue, including the paperwork and delays that go along with it,” says Hanna. Additionally, patients that must travel out of the country also tend to lack access to the manufacturer patient assistance programs. The need to travel out of province or out of the country also has a significant impact on patient family members and caregivers who need to accompany them and take substantial time off work.
Advocating for equitable access
The Cancer Collaborative has been working with the Leukemia and Lymphoma Society of Canada, Lymphoma Canada, and the Ac2orn (Advocacy for Canadian Childhood Oncology Research Network) to advocate for CAR T-cell therapy access across Canada. “Our ultimate goal is to have at least one treatment centre in every province,” says Hanna.
In the meantime, she encourages patients and their families to advocate for themselves. “Get as much information as you can to see if you’re eligible to receive it and find out about the manufacturer assistance programs and what your province is covering in terms of travel, accommodation, and follow-up care. It’s also really important that people understand what CAR T-cell therapy is,” says Hanna.
As promising a therapy as CAR T-cell is, it isn’t suitable for every patient. It also comes with risks and requires close in-hospital monitoring for specific side effects such as cytokine release syndrome, which can lead to systemic inflammation in the patient, or immune effector cell-associated neurotoxicity syndrome.
This content was supported by a member of Innovative Medicines Canada.