Christine Freestone was diagnosed with stage III non-Hodgkin Lymphoma, follicular Lymphoma in 2016.

CAR T-Cell Therapy Lies Ahead for the Future of Cancer Treatment

by Mackenzie Gignac

In medicine, new treatment options are constantly being developed to achieve a better life for patients.

One new therapy that has received traction in recent years is Chimeric Antigen Receptor (CAR) T-Cell therapy. CAR T-Cell therapy is a form of immunotherapy, where your body uses its own immune system to directly target cancer cells.

As it stands this new form of treatment is very new in Australia and is only available as a treatment option for certain types of Lymphomas and Leukemias. However, some doctors see CAR T-Cell as the way of the future for a broad variety of blood cancer treatments.

Professor and clinical lead for Low-Grade Lymphomas at Peter MacCallum Cancer Centre Constantine (Con) Tam was able to secure a clinical trial for this cutting edge treatment option for one of his Lymphoma patients, Christine Freestone.

Christine was first diagnosed with stage III non-Hodgkin Lymphoma in 2016. Prof Tam led the medical team that treated Christine for her Lymphoma. Tam said given her age at the time of diagnosis the first treatment attempt was to use full-body radiation.

There were many negative effects that Christine suffered throughout her treatment, one of these being the burning pain in her throat. ‘You can’t physically eat, it was just too painful,’ she said. ‘I lived on jelly and drinks. You couldn’t eat. You couldn’t swallow.’

Christine also noted that radiation caused her skin to peel, which is something people tend to overlook when it comes to radiation treatment. ‘Some things which people don’t think about, is it’s like having a terrible sunburn,’ she said. ‘My arms, my back, they all were peeling.’

The radiation treatment option was meant to kill off the cancer for good. So when Christine’s non-Hodgkin Lymphoma came back this time in stage IV, it came as a shock to her and her family.

‘You think you got through it alright the first time. You’re hoping you don’t have to do it again,’ she said.

This time Christine underwent six intensive cycles of chemotherapy. The treatment was so hard on her body that it made her physically ill.

Christine battled health complications as the rounds of chemotherapy treatment continued. In the last two rounds of treatment, she had to be admitted to the hospital on both occasions due to infections from the RCHOP chemotherapy drugs.

‘It’s just so hard on your body,’ Christine said. ‘I don’t think people understand it unless they’ve been through it.’

During this time the effects of cancer treatment not only had physical effects but strenuous psychological effects as well.

‘You feel sort of isolated, especially when you are at the hospital and there is no one around,’ she said. ‘That’s the hardest part. You could be feeling the worse that you could possibly be, and then you start to have breakdowns.’

On top of the isolation, the treatment took her away from her children. Christine lives in rural Victoria and had all her treatment in Melbourne. ‘Leaving my kids at home and not being around them… that was hard,’ Christine said.

After her six cycles of chemotherapy, Christine relapsed a third time. ‘I still didn’t feel 100 percent, but I just put it down to the chemotherapy treatment,’ Christine said.

This time Prof Tam recommended an anticancer treatment still new to Australia, CAR T-Cell therapy treatment.

The CAR T-Cell treatment process is a minor medical miracle. First, the patient’s own T cells are collected from the patient via an apheresis blood draw. Then, the cells are sent to a medical lab that has the capability to reengineer DNA and insert chimeric antigen receptors (CARs) into the T cells, turning them into “robotic soldiers” dedicated to attacking lymphoma. Once these cells are made, they are sent back over to be infused into the patient. This is done in a one-off injection dose.

Prof Tam was the Australian lead for the international team that developed CAR T-cell treatment for diffuse large cell lymphoma. However, for Christine’s type of lymphoma, the only way to access CAR T-cells was to join a clinical trial under Prof Tam’s supervision.

Christine explains her experience during the CAR T-Cell clinical trial, ‘CAR T-Cell was a once-off treatment. It’s not like you’re going in every three weeks like chemo,’ she said. Christine said with the constant rounds of chemotherapy, she really started to dread each chemo cycle. ‘Chemo makes you feel sick from the minute it hits your blood,’ she said.

The difference between Christine’s chemotherapy versus her CAR T-Cell treatment was like night and day. ‘With chemotherapy you’re nauseous all the time, always feeling sick and tired. With CAR T it’s so much easier. I felt good all of the sudden,’ she said.

Christine underwent CAR T-Cell therapy in May 2019 and achieved complete remission of her stage IV non-Hodgkin Lymphoma.

Since this treatment started, Christine has had minimal side effects and is doing the best she’s ever been since first being diagnosed with cancer in 2016. ‘My cancer is gone,’ she said. ‘If you can get into the trials then do it. It has taken my cancer away.’

Christine said her willingness to pursue the CAR T-Cell treatment stems from a selfless desire to help others as well. ‘It might take a few of us to do the trials, but it will make it easier for others in the future,’ she said. ‘For others to get access to these treatments, it’s worth it.’

CAR T-Cell therapy is still very, very new in the medical world. However, this line of treatment is set to be at the forefront of treatment for blood cancers, and this highly specialised option has the potential to offer future cancer patients a brighter and easier outcome by harnessing the power of their own immune systems.