How Do CAR-T Cell Therapies Work?

Chimeric antigen receptor (CAR) T-cell therapies are a class of drugs used to treat mantle cell lymphoma (cancer of white blood cells), acute lymphoblastic leukemia (a type of cancer of the blood and bone marrow), multiple myeloma (cancer that forms in a type of white blood cell called plasma cell), non-Hodgkin's lymphoma (cancer of the lymphatic system), and large B-cell lymphoma (cancer that starts in white blood cells called lymphocytes).

CAR-T cell therapy involves altering the genes inside T cells (a type of white blood cell) to help them attack the cancer cells; hence, it is also known as cell-based gene therapy medications.

In CAR T-cell therapies, T cells are collected from the patient’s blood using a procedure called leukapheresis, processed in the laboratory by adding a gene for a man-made receptor called “chimeric antigen receptor” or CAR, and then infused back into the patient. This helps T cells better identify specific cancer cell antigens and target cancerous cells and eventually kill them.

CAR-T cell therapies are administered as a suspension (liquid) to be injected intravenously (into a vein), typically over 30 to 60 minutes as a one-time dose. 

CAR-T cell therapies work in the following ways:

• They belong to a class of medications called “autologous cellular immunotherapy,” a type of medication prepared using cells from the patient’s blood. 
• They work by inducing the body’s immune system to fight the cancer cells.
• Each dose of the medication consists of the patient’s genetically modified T-cells that were previously collected. The modified version of the T cell expresses a new gene that targets and kills the lymphoma cells.

CAR-T cell therapies are used to treat conditions such as:

• Multiple myeloma (cancer that forms in a type of white blood cell called plasma cell)
• Large B-cell lymphoma (cancer that starts in white blood cells called lymphocytes)
• Follicular lymphoma (a slow-growing or indolent form of non-Hodgkin’s lymphoma)
• Mantle cell lymphoma (cancer of white blood cells)
• Acute lymphoblastic leukemia (a type of cancer of the blood and bone marrow)
• Non-Hodgkin’s lymphoma (cancer of the lymphatic system)

Some of the common side effects include:

• Nausea
• Vomiting
• Constipation
• Diarrhea
• Abdominal pain
• Back pain
• Dry mouth/eyes
• Headache
• Tiredness/weakness
• Loss of appetite

Other rare side effects include:

• Dizziness 
• Fatigue 
• Insomnia 
• Hypotension (low blood pressure)
• Hair loss
• Chills, sore throat, fever, or cough
• Rash/hives/itching
• Weight loss
• Hematuria (presence of blood in urine)
• Anemia (low red blood cell count)
• Thrombocytopenia (low blood platelet count)
• Dyspnea (shortness of breath)
• Swelling of the eyes, face, lips, tongue, throat, arms, hands, feet, ankles, or lower legs
• Tachycardia (heart rate over 100 beats per minute)
• Hypophosphatemia (low blood phosphate level)
• Hyperglycemia (high blood glucose level)
• Hypokalemia (low blood potassium level)
• Tremors (an involuntary, rhythmic muscle contraction, leading to shaking movements in one or more parts of the body)
• Cytokine release syndrome (an acute systemic inflammatory syndrome characterized by fever and multiple organ dysfunction)
• Encephalopathy (damage or disease that affects the brain)

Information contained herein is not intended to cover all possible side effects, precautions, warnings, drug interactions, allergic reactions, or adverse effects. Check with your doctor or pharmacist to make sure these drugs do not cause any harm when you take them along with other medicines. Never stop taking your medication and never change your dose or frequency without consulting your doctor.

Generic and brand names of CAR-T cell therapies include:

• Abecma
• Axicabtagene ciloleucel
• Brexucabtagene autoleucel
• Breyanzi
• Ciltacabtagene autoleucel (pending Food and Drug Administration approval)
• Idecabtagene vicleucel
• Kymriah
• Lisocabtagene maraleucel
• Tecartus
• Tisagenlecleucel
• Yescarta