Human cell-based therapy increases survival prospects for cancer patients

Surgery, chemotherapy and radiotherapy are the best-known oncologic therapies, but new modalities have emerged and improved prognosis.

In hematological tumors (which originate from blood cells), treatments with so-called CAR-T cells can have better results than conventional ones and increase patients’ survival prospects.

CAR-T is an immunocellular therapy, that is, its production is based on human cells and their immune capacity, explains Marta Maria Moreira Lemos, medical coordinator of the hemotherapy and cell therapy sector at ACCamargo.

The implementation of structures for treatment with this technology, the impact of therapy on the journey of the cancer patient and the challenges of access were discussed in a panel organized by the ACCamargo Cancer Center at the 9th Todos Juntos Contra o Câncer Congress, held by Abrale (Brazilian Association of Lymphoma and Leukemia). Promoted this Thursday (29), the panel was mediated by Wilson Leite Pedreira Jr., director of business and relationship at the hospital.

Multiple myeloma, acute lymphoblastic leukemia B (ALL-B), and some non-Hodgkin’s lymphomas, which spread in a disorderly fashion, may respond well to treatment.

Development begins with the collection of T lymphocytes (defense cells) from the patient. The material is sent to a laboratory, where it is genetically modified by means of viruses that invade lymphocytes and alter the DNA to make them connect with tumor cells to attack and eliminate them.

After this process, the modified defense cells are kept in culture, so that they multiply until they reach a sufficient quantity to destroy the cancer cells.

In up to 60 days, the process results in the final product, which is sent to the hospital and applied to the patient with a blood transfusion. In Brazil, says Lemos, the first experience with CAR-T took place in 2019, at the Hospital das Clínicas of the Faculty of Medicine of Ribeirão Preto at USP (University of São Paulo).

In the same year, ACCamargo started planning the infrastructure for implementing the CAR-T, which involved investments in factors such as professional qualification, definition of the patient’s journey, creation and review of clinical protocols and adequacy of the physical space, says nurse Vanessa Camandoni , specializing in oncology and operations manager responsible for the hospital’s outpatient therapy area.

Prior to receiving cell-immune treatment, the patient is evaluated in consultation and their eligibility for therapy is discussed.

If the case is compatible with CAR-T, the collection, production and application process begins, followed by early monitoring and long-term follow-up, steps in which the patient is hospitalized so that the multidisciplinary team can observe side effects, explains Camandoni.

If the multidisciplinary team is trained and identifies symptoms of adverse events early, such as fever, it is possible to deal well with possible side effects, says Jayr Schmidt Filho, leader of the Reference Center for Hematologic Neoplasms at ACCamargo

According to him, CAR-T is particularly beneficial for patients with multiple myeloma, acute B-lymphoblastic leukemia (B-ALL), diffuse large B-cell lymphoma and follicular lymphoma who have already undergone other types of treatment, but have not had a good response or have had relapse.

—both non-Hodgkin’s lymphomas, that is, they are tumors that spread in a disorderly way, unlike Hodgkin’s lymphomas—

The CAR-T treatments already approved by Anvisa (National Health Surveillance Agency) are in the pricing phase by the CMED (Drug Market Regulation Chamber), an interministerial body that discusses and establishes the maximum prices for medicines in the country, says Pedreira. Jr.

He estimates the cost to be approximately US$500,000. Analyzing the price, the positive impact on survival with patient quality and other alternative therapies, international studies show that the cost-effectiveness is justified, says the director.

Despite the effectiveness, completes Pedreira Jr., the SUS (Sistema Único de Saúde) will have difficulties in adopting CAR-T therapies due to the lag in the pay scale, the scarcity of health resources and the country’s delay in primary cancer care. —that is, it is still not guaranteed that patients have consultations and exams in a timely manner to have an early diagnosis of cancer.