Health Status, not Age, Should Determine CAR T Eligibility
For more than six years, Moffitt Cancer Center has been at the forefront of personalized therapy that uses a patient’s own cells to combat cancer. Chimeric antigen receptor T-cell therapy, or CAR T, has revolutionized the treatment of lymphoma and other blood cancers.
But some physicians have been reluctant to refer older patients for the treatment. According to Dr. Frederick Locke, vice chair of the Blood and Marrow Transplant and Cellular Immunotherapy Department and co-leader of the Immuno-Oncology Program at Moffitt, age should not be a factor when considering the treatment for large B-cell lymphoma.
“There are other factors to consider,” said Locke, who recently presented new research on the topic at the American Society of Hematology annual meeting. “Factors like liver disease, for example, are associated with poor response. What we found is that elderly patients did not have worse efficacy outcomes when treated with CAR T.”
CAR T therapy reengineers a patient’s own immune cells to fight cancer. For this treatment, the patient’s T cells are removed and modified with additional receptors to help identify, attack and ultimately destroy the cancer cells. The reengineered T cells are then infused back into the patient’s body in a single treatment, enabling the body’s immune system to better combat the disease.
Researchers have found that any patient healthy enough for CAR T therapy, regardless of age, should receive it. Age alone is not a barrier, Locke said.
“We can make the stem cell transplant analogy here,” Locke said. “Many centers have age cutoffs. Moffitt does not. We don’t want referring physicians to assume that there are age limits and not refer patients for treatment. We want to encourage physicians to refer them to us for evaluation.”
It’s important for community physicians to consider all forms of treatment, especially in cancer patients. Locke hopes that doctors will rely on the expert opinions of cell therapy specialists, who may be able to better determine who is a good candidate for CAR T and who is not.
“A patient who is wheelchair bound and who can’t tolerate chemotherapy is likely not a good candidate for CAR T,” Locke said. “But a patient in their 70s with hypertension and diabetes may still be eligible. It’s important to not rule them out and to consider all factors.”
CAR T continues to evolve and improve as more research is done in the field. Patients who had no other viable treatment options at the time are now in ongoing complete remission six years later after a single infusion of CAR T cells, Locke said. Those successes seem to support the stance that anyone eligible for the treatment should be considered.
“Older patients can safely be treated with CAR T-cell therapy with careful planning and evaluation of comorbidities,” Locke said.
