Rumnting,
You and your husband are truly pioneers! Please let us know how your husband does. We are all pulling for him.
Lyn
Forums
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Christa's Mom - Name: Christa's Mom
- Who do you know with myeloma?: Husband
- When were you/they diagnosed?: September, 2010
- Age at diagnosis: 53
Re: CAR T-cell therapy for multiple myeloma
Hello Rumnting:
I certainly agree that it's both exciting and worrisome at the same time. The worrisome part, of course is the newness of the therapy. I think that there is no better place to do this than at Mayo. In recent years, patients who stepped up and underwent clinical trials for several new drugs have done very very well. I hope that CAR T-cell therapy is a home run, and beats all the other new drugs, and that your husband is the beneficiary of this. Good luck to you both.
I certainly agree that it's both exciting and worrisome at the same time. The worrisome part, of course is the newness of the therapy. I think that there is no better place to do this than at Mayo. In recent years, patients who stepped up and underwent clinical trials for several new drugs have done very very well. I hope that CAR T-cell therapy is a home run, and beats all the other new drugs, and that your husband is the beneficiary of this. Good luck to you both.
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JPC - Name: JPC
Re: CAR T-cell therapy for multiple myeloma
Lyn - Thanks for the link to the article.
Rumnting - Sounds like between you and your husband you are going into this in the right frame of mind. You are aware of the potential risks but hopeful for the reward the therapy can potentially provide. Best of luck and keep us updated on how things progress. I think it would be interesting for us to get an idea what type of things you are told about the potential risks and rewards of the therapy.
Rumnting - Sounds like between you and your husband you are going into this in the right frame of mind. You are aware of the potential risks but hopeful for the reward the therapy can potentially provide. Best of luck and keep us updated on how things progress. I think it would be interesting for us to get an idea what type of things you are told about the potential risks and rewards of the therapy.
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Mark11
Re: CAR T-cell therapy for multiple myeloma
This just hit the wires regarding another death in one of Juno Therapeutics trials involving a leukemia patient. So sad.
https://www.thestreet.com/story/13903738/1/juno-therapeutics-car-t-study-halts-following-another-additional-patient-death.html
https://www.thestreet.com/story/13903738/1/juno-therapeutics-car-t-study-halts-following-another-additional-patient-death.html
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: CAR T-cell therapy for multiple myeloma
Rumnting,
Is Mayo participating in this BCMA trial with other institutions? I ask because I know that at least one other place (U Penn) is running a BCMA trial, and I'm wondering if it's the same one with multiple sites for enrollment
Tracy.
Is Mayo participating in this BCMA trial with other institutions? I ask because I know that at least one other place (U Penn) is running a BCMA trial, and I'm wondering if it's the same one with multiple sites for enrollment
Tracy.
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Tracy J - Name: Tracy Jalbuena
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: 2014
- Age at diagnosis: 42
Re: CAR T-cell therapy for multiple myeloma
Following up on Multibilly's post about Juno stopping its JCAR015 CAR-T trial for the second time earlier this week due to the deaths of two more patients, here are some more details about the trial and the unfortunate results: http://pharmaphorum.com/news/juno-car/
These results are especially disappointing for me because one of my myeloma friends was recently diagnosed with acute lymphoblastic leukemia (ALL), the disease targeted in his trial.
Mike
These results are especially disappointing for me because one of my myeloma friends was recently diagnosed with acute lymphoblastic leukemia (ALL), the disease targeted in his trial.
Mike
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mikeb - Name: mikeb
- Who do you know with myeloma?: self
- When were you/they diagnosed?: 2009 (MGUS at that time)
- Age at diagnosis: 55
Re: CAR T-cell therapy for multiple myeloma
Tracy: I don't know the answer to that.
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rumnting - Who do you know with myeloma?: husband
- When were you/they diagnosed?: 4/9/11
- Age at diagnosis: 54
Re: CAR T-cell therapy for multiple myeloma
Thanks for posting, Multibilly.
In my opinion, this one was especially tragic because it seemed clear that this particular CAR construct was causing this problem. If you read my earlier post in the thread, fludarabine is used with many immunotherapies, and you do not see this problem being as severe as it was in this trial. This is the downside to pressure "to find a cure for cancer" and thinking one type of therapy, in this case immunotherapy, is "the cure" for cancer. I have benefited greatly from immunotherapy, but it should be viewed as part of a comprehensive strategy that includes chemotherapy and other therapies to gain the optimal outcome – long-term disease control with good quality of life.
There was an excellent article on immunotherapy in this past weekend's New York Times. These "immunotherapy drugs" sound a lot like chemotherapy/novel agents. You need to keep taking them and put up with side effects.
Excerpt:
"'We are playing with fire,' said Dr. John Timmerman, an oncologist and immunotherapy researcher at the University of California, Los Angeles, who recently lost a patient to side effects. The woman’s immunotherapy drugs had successfully “melted away” her cancer, he said, but some weeks later, she got cold and flulike symptoms and died in the emergency room from an inflammatory response that Dr. Timmerman described as “a mass riot, an uprising” of her immune system.
'We’ve heard about immunotherapy as God’s gift, the chosen elixir, the cure for cancer,' he said. 'We haven’t heard much about the collateral damage.'
Despite the warnings, physicians like Dr. Timmerman remain hugely supportive of drugs that are saving the lives of people who would otherwise die. Far better to cope with diabetes, hepatitis or arthritis, the thinking goes, than to die. Most reactions are not nearly so bad and are treatable."
Source:
Richtel, Matt, "Immune System, Unleashed by Cancer Therapies, Can Attack Organs", New York Times, Dec 3, 2016 (full text of article)
In my opinion, this one was especially tragic because it seemed clear that this particular CAR construct was causing this problem. If you read my earlier post in the thread, fludarabine is used with many immunotherapies, and you do not see this problem being as severe as it was in this trial. This is the downside to pressure "to find a cure for cancer" and thinking one type of therapy, in this case immunotherapy, is "the cure" for cancer. I have benefited greatly from immunotherapy, but it should be viewed as part of a comprehensive strategy that includes chemotherapy and other therapies to gain the optimal outcome – long-term disease control with good quality of life.
There was an excellent article on immunotherapy in this past weekend's New York Times. These "immunotherapy drugs" sound a lot like chemotherapy/novel agents. You need to keep taking them and put up with side effects.
Excerpt:
"'We are playing with fire,' said Dr. John Timmerman, an oncologist and immunotherapy researcher at the University of California, Los Angeles, who recently lost a patient to side effects. The woman’s immunotherapy drugs had successfully “melted away” her cancer, he said, but some weeks later, she got cold and flulike symptoms and died in the emergency room from an inflammatory response that Dr. Timmerman described as “a mass riot, an uprising” of her immune system.
'We’ve heard about immunotherapy as God’s gift, the chosen elixir, the cure for cancer,' he said. 'We haven’t heard much about the collateral damage.'
Despite the warnings, physicians like Dr. Timmerman remain hugely supportive of drugs that are saving the lives of people who would otherwise die. Far better to cope with diabetes, hepatitis or arthritis, the thinking goes, than to die. Most reactions are not nearly so bad and are treatable."
Source:
Richtel, Matt, "Immune System, Unleashed by Cancer Therapies, Can Attack Organs", New York Times, Dec 3, 2016 (full text of article)
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Mark11
Re: CAR T-cell therapy for multiple myeloma
Here is a recent article that nicely summarizes some points that have been made in the thread so far.
“Probably the most critical factor for any CAR T-cell therapy is the choice of target antigen. Appropriate target antigens for myeloma are not abundant. Common multiple myeloma antigens such as CD38, CD56, and CD138 are all expressed on essential normal cells as well,” he said. “Another complicating factor is that the myeloma cells of any particular patient are clearly made up of many subclones, so heterogeneity of antigen expression is probable.”
It is thought that the persistence of myeloma depends on a myeloma stem cell that has the phenotype of a mature B cell. Two CAR T-cell approaches in development are targeting B-cell antigens: In research spearheaded by the University of Pennsylvania, anti-CD19 CAR T cells (CTL019) are infused after autologous stem cell transplantation, whereas Baylor College of Medicine researchers are targeting kappa light chains, Dr. Kochenderfer said.
“Targeting myeloma stem cells is an interesting and promising approach, but the results so far are early,” he said. “Also, we need to better define the phenotype of the myeloma stem cell.”
Source:
Helwick, C, "CAR T-Cell Therapy Emerging in Multiple Myeloma," ASCO Post, March 10, 2017 (full text of article)
Here is a link to an article in the business press that I thought discussed some relevant issues with regard to CAR T cell therapy as well.
"With Kite Pharma (NASDAQ: KITE) of Santa Monica, CA, nearly ready to ask the FDA to review its CAR-T axicabtagene ciloleucel as a treatment for adults with non-Hodgkin lymphoma (NHL), the field’s first-ever approval could be months away. International drug giant Novartis (NYSE: NOV) might not be far behind, with a CAR-T for pediatric patients with acute lymphoblastic leukemia (ALL).
For now, the Kite and Novartis products are meant for narrow groups of patients who have failed to improve with other therapies, including chemotherapy and bone-marrow transplant. Their doctors are thrilled to have the first generation CAR-Ts. “The patients whom these trials are targeting, they’re typically highly refractory, they have no options left,” says Krishna Komanduri, director of the Sylvester Comprehensive Cancer Center Adult Stem Cell Transplant Program at the University of Miami.
But is a last-ditch lifeline for patients with severe cases of two blood cancers the ceiling for CAR-T? Doctors, patients, and investors who have poured billions of dollars into the field have much higher hopes that the living cells will stand alone as long-term treatments, even cures, not just improvements upon current standards or temporary bridges to get patients healthy enough for bone-marrow transplants—which are fraught with risks, too.
Source:
Lash, A, "Possible Cures. Mystery Deaths. Daunting Costs. Can CAR-T Be Tamed?," Xconomy, March 13, 2017 (link to full text of article)
Mark
“Probably the most critical factor for any CAR T-cell therapy is the choice of target antigen. Appropriate target antigens for myeloma are not abundant. Common multiple myeloma antigens such as CD38, CD56, and CD138 are all expressed on essential normal cells as well,” he said. “Another complicating factor is that the myeloma cells of any particular patient are clearly made up of many subclones, so heterogeneity of antigen expression is probable.”
It is thought that the persistence of myeloma depends on a myeloma stem cell that has the phenotype of a mature B cell. Two CAR T-cell approaches in development are targeting B-cell antigens: In research spearheaded by the University of Pennsylvania, anti-CD19 CAR T cells (CTL019) are infused after autologous stem cell transplantation, whereas Baylor College of Medicine researchers are targeting kappa light chains, Dr. Kochenderfer said.
“Targeting myeloma stem cells is an interesting and promising approach, but the results so far are early,” he said. “Also, we need to better define the phenotype of the myeloma stem cell.”
Source:
Helwick, C, "CAR T-Cell Therapy Emerging in Multiple Myeloma," ASCO Post, March 10, 2017 (full text of article)
Here is a link to an article in the business press that I thought discussed some relevant issues with regard to CAR T cell therapy as well.
"With Kite Pharma (NASDAQ: KITE) of Santa Monica, CA, nearly ready to ask the FDA to review its CAR-T axicabtagene ciloleucel as a treatment for adults with non-Hodgkin lymphoma (NHL), the field’s first-ever approval could be months away. International drug giant Novartis (NYSE: NOV) might not be far behind, with a CAR-T for pediatric patients with acute lymphoblastic leukemia (ALL).
For now, the Kite and Novartis products are meant for narrow groups of patients who have failed to improve with other therapies, including chemotherapy and bone-marrow transplant. Their doctors are thrilled to have the first generation CAR-Ts. “The patients whom these trials are targeting, they’re typically highly refractory, they have no options left,” says Krishna Komanduri, director of the Sylvester Comprehensive Cancer Center Adult Stem Cell Transplant Program at the University of Miami.
But is a last-ditch lifeline for patients with severe cases of two blood cancers the ceiling for CAR-T? Doctors, patients, and investors who have poured billions of dollars into the field have much higher hopes that the living cells will stand alone as long-term treatments, even cures, not just improvements upon current standards or temporary bridges to get patients healthy enough for bone-marrow transplants—which are fraught with risks, too.
Source:
Lash, A, "Possible Cures. Mystery Deaths. Daunting Costs. Can CAR-T Be Tamed?," Xconomy, March 13, 2017 (link to full text of article)
Mark
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Mark11
Re: CAR T-cell therapy for multiple myeloma
This continues to be such an interesting topic as the intracacies of it are being learned. I was diagnosed with acute lymphocytic leukemia (ALL) as a secondary cancer in October 2016. At the time of diagnosis, my oncologist said that after induction I might be a candidate for the investigational CD19-targeted CAR T-cell therapy to treat ALL. He also said that I might be a candidate for the monocolonal antibody study for Blincyto (blinatumomab). After the bone marrow biopsy was done when I completed 2 rounds of treatment, I was minimal residual disease (MRD) negative for ALL.
Both my oncologist and I were ecstatic about the good response that I've had to induction treatment, which hasn't been fun. But, he said that since I responded so well, I probably wouldn't qualify for either of the trials above. I would probably start maintenance with the traditional treatment of oral methotrexate.
In addition to the ALL, my multiple myeloma started to increase, so I have now restarted treatment for that with weekly injections of Velcade. That also seems to be going well, although I haven't gotten the latest results of my M-spike yet.
Interestingly, for me, when the bone marrow biopsy was done, the sample was tested for the surface antigens on my myeloma cells. I guess that will help my oncologist decide on future treatment based on what antigens the newer drugs target.
Nancy in Phila
Both my oncologist and I were ecstatic about the good response that I've had to induction treatment, which hasn't been fun. But, he said that since I responded so well, I probably wouldn't qualify for either of the trials above. I would probably start maintenance with the traditional treatment of oral methotrexate.
In addition to the ALL, my multiple myeloma started to increase, so I have now restarted treatment for that with weekly injections of Velcade. That also seems to be going well, although I haven't gotten the latest results of my M-spike yet.
Interestingly, for me, when the bone marrow biopsy was done, the sample was tested for the surface antigens on my myeloma cells. I guess that will help my oncologist decide on future treatment based on what antigens the newer drugs target.
Nancy in Phila
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NStewart - Name: Nancy Stewart
- Who do you know with myeloma?: self
- When were you/they diagnosed?: 3/08
- Age at diagnosis: 60
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