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T cells for patient-specific cancer treatment
T cell therapy is an investigational approach that is being assessed for the patient‑specific treatment of cancer. T cells can recognise and kill cancer cells; by making large numbers of such cells, we can potentially treat large and metastatic cancers.
In adoptive T cell therapy, relatively large numbers of cancer specific T cells are generated outside the body and then re‑infused. Cancer‑specific T cells can be made in three ways:
How is treatment administered?
Based on preclinical and clinical research, we now know that the chance of survival of the infused cells is greater in patients that have been pre‑treated with lympho‑depleting, but non‑myeloablative chemotherapy. In fact, there is also a chance that the cells multiply post-infusion if administered in pre‑treated patients. This multiplication is the result of a phenomenon known as “homeostatic expansion” the chemotherapy depletes normal T cells and the body then produces cytokines, such as IL7 and IL15, which support the survival and proliferation of the infused cancer‑specific T cells.
Interleukin‑2 (IL2) is often administered in conjunction with T cell therapy; however, the precise value of IL2, or indeed of any other cytokines in this scenario, is the subject of ongoing research.
The current situation
Trials of genetically engineered T cells are at an earlier stage of development. Again, trials in melanoma have shown some successes at the National Cancer Institute in Washington (USA). Trials in Manchester focus on using T cells targeted to gastrointestinal cancer or lymphoma, using artificial receptors, which produce excellent preclinical activity. The trials are ongoing and are some of the first in the world to combine chemotherapy and IL2 with engineered T cells using artificial receptors. The trial targeting gastrointestinal cancers will finish towards the end of 2010, but the results look encouraging so far.
Will cost hinder uptake?
Even though the cost is high, the benefits are large (currently for melanoma patients at least) and the key advantage is that this is a one‑off treatment that has long‑lasting benefits. Thus, even at this early stage of development, the cost benefit is probably comparable to other new cancer treatments, which typically require continued use for months or years.
Based on a contribution by Professor Robert Hawkins, Cancer Research UK Director of Medical Oncology at Christie Hospital, Manchester (UK).