Frequently Asked Questions About CAR-T
CAR-T cell therapy is an individualized approach to treating certain types of cancer. This breakthrough type of cell and gene therapy harnesses the power of a patient's own immune system to destroy cancer cells.
With CAR-T cell therapy, a patient’s T cells are reprogrammed into CAR-T cells, which enhances their ability to detect and destroy cancer cells.
T cells are a part of the immune system that help defend the body.
T cells detect and destroy infected or cancerous cells by looking for certain antigens, which are markers that help the immune system identify normal cells from infected or cancerous cells. But the antigens on cancerous cells look like normal antigens, and normal T cells cannot recognize them.
T cells reprogrammed to be CAR-T cells
In CAR-T cell therapy, a patient’s T cells are modified and reprogrammed with CARs, or chimeric antigen receptors.
When a CAR is added to the patient’s own T cells, they become CAR-T cells, and they’re able to recognize specific characteristics on certain types of cancer cells. CAR-T cells specifically target certain receptors on normal and cancerous B cells, breaking them down and destroying them.
Collecting the T cells
A patient's white blood cells, including T cells, are taken out of the body through a specialized process called leukapheresis, where blood is removed from the patient and separated. This is done at a certified CAR-T treatment center. Depending on the specific type of CAR-T cell therapy, the T cells are frozen before they are sent to a manufacturing facility for reprogramming.
Reprogramming the cells
Using an inactive virus (known as a viral vector), T cells are reprogrammed by introducing DNA into them, to produce chimeric antigen receptors (CARs) on the surface of the T cells. The process usually takes less than a month, but timing can vary. Once these new, patient-specific CAR-T cells are armed to detect and destroy cancer cells, they are frozen and sent back to the CAR-T treatment center where the patient is being treated.
Preparing for infusion
Within 2 weeks before the CAR-T cells are infused, most patients will receive a short course of chemotherapy that helps prepare the body to receive their reprogrammed CAR-T cells. This is referred to as “lymphodepletion” and is done to create space for the new CAR-T cells to expand and grow.
Infusing the cells
The reprogrammed patient-specific CAR-T cells are delivered into the patient’s blood through an IV infusion, which is done at a certified CAR-T treatment center. CAR-T cell therapies are designed to be one-time therapies and an infusion usually takes less than 30 minutes.
Detecting and destroying cells
Within the patient’s body, CAR-T cells may detect and destroy normal and cancerous B cells. CAR-T cell therapy may provide long-lasting remission as the patient’s immune system reproduces its own CAR-T cells.
Monitoring after therapy
CAR-T cell therapy requires both short-term monitoring and ongoing follow-up visits. A health care team will monitor patients both to make sure the CAR-T cell therapy is working, and to watch for side effects.
In the short term, it is necessary for patients to stay in or near their CAR-T treatment center for at least 4 weeks after infusion. Most side effects occur within the first 2 months after CAR-T cell therapy infusion, so close monitoring is important during this time. After that, subsequent medication and an ongoing follow-up schedule will be determined by the health care team to check on the patient’s progress. The doctor will continue to follow-up with the patient to understand the long-term results of the treatment.
Patients should consult their care team to determine if they are eligible for a CAR-T cell therapy. As with all medical treatment, individual results may vary; not all patients will respond to treatment with CAR-T cell therapy. Individuals should work with their care team to monitor their status or treatment, as some who respond initially may relapse over time. CAR-T cell therapy is not available for all cancer types.
Role of the Caregiver
The continued support of one or more dedicated caregivers is an invaluable part of a cancer care team. The role of a caregiver isn’t always easy. Caregivers have a huge influence on how someone deals with cancer. When it comes to CAR-T cell therapy, caregivers play a critical role throughout treatment, such as:
- Managing appointments, housing, and transportation
- Researching treatment options
- Keeping track of questions for the health care team, taking notes, and listening in at appointments
- Monitoring for side effects after therapy
- Providing emotional support and advice
CAR-T cell therapies are FDA approved for certain kinds of advanced B-cell blood cancer and are available at select CAR-T treatment centers across the United States. Ongoing research is also being conducted in clinical trials for other indications, including additional types of blood cancer, and solid tumors such as lung cancer, breast cancer, and ovarian cancer. Patients can learn more about clinical trials by visiting cancer.gov.
If you are a patient and want to find out if you are eligible for CAR-T cell therapy, or the caregiver of a patient who might be eligible, speak with your health care provider. Below are a few questions that might help you begin the conversation with your provider:
Is CAR-T cell therapy an appropriate option for my kind and stage of cancer?
How does my treatment history affect my eligibility for CAR-T cell therapy? What about my other health conditions?
What are the steps of the treatment process? What will I need to do to prepare for each step of the treatment process?
Will I need a caregiver throughout the process?
How long until I can resume my normal routine (work or school) after my CAR-T cell therapy ends?
Are there CAR-T treatment centers near me?
What is the follow-up schedule after receiving CAR-T cell therapy?
What are the possible side effects of CAR-T cell therapy?
The Cancer Support Community, the Emily Whitehead Foundation, and Novartis offer education and support and can help patients search for CAR-T treatment centers and clinical trials.
If you are a patient or caregiver looking for information, talking to your care team is an important first step to understand if CAR-T cell therapies are right for you. For other questions about CAR-T cell therapies, including information, resources, and treatment centers where they are offered, you may call 1-855-MED-INFO (1-855-833-4636).
If you are looking for support after a loved one did not respond to treatment with a CAR-T cell therapy or for someone who is not eligible for CAR-T cell therapies, please visit the Cancer Support Community, which can provide you with additional resources and support.
My-T Heroes Patient Advocacy Support
My-T Heroes is brought to you by Novartis in collaboration with the Cancer Support Community and the Emily Whitehead Foundation, independent organizations in the cancer community. Novartis is reimagining medicine to power breakthrough innovation in cell and gene therapy. We’d like to thank these organizations for their dedication in helping patients who have been impacted by cancer.