THE CHOICE of the name for the new AIL (Italian Association against Leukemia, Lymphoma and Myeloma) campaign Eleonora finds it very effective. “CAR-T future destination”. Because, she says, CAR-T represented exactly this for her. “A real springboard to my new future,” he recalls. Eleonora was diagnosed with primary mediastinal lymphoma in the fourth stage and the various therapies tried had not given the desired results. But then, after a radiotherapy that had helped to significantly reduce the size of his tumor, CAR-T therapy would have changed his history: today, after a year and 8 months, there is no trace of the tumor.
In 2019 Eleonora had heard about this therapy from a hematologist on TV. And she, in turn, had talked about it to her doctor, who had shown her what the path should be: first the other lines of treatment. A step at a time. Eleonora’s story tells well the path and the promises offered by CAR-T: a revolutionary, innovative therapy, which aims to fight tumors by arming the cells of the immune system (the patient’s T cells), modifying them in the laboratory to make them more aggressive towards diseased cells. Like? By mounting on the cells themselves a receptor (CAR, Chimeric Antigen Receptor) capable of recognizing and thus attacking the tumor cells.
But it is not a first choice therapy, nor a therapy for everyone, nor easy: from the point of view of production (those available today outside the trials are prepared by the centers of the pharmaceutical companies that distribute them) and administration ( qualified centers are needed, which have experience in the field of transfusions and handling of live products), but also from the point of view of patients. The side effects of the therapy (from the so-called cytokine storm to neurological toxicity) can also be serious, although over time researchers and clinicians have learned to manage them. And all this is right for patients and caregivers, but also the general public, to know.
“The clinical history of CAR-T is now ten years old – says Sergio Amadori, national president of AIL – and the demonstrations that came from the clinic were revolutionary. Even for the so-called incurable patients, who had exhausted all therapeutic possibilities, something new arrived, which gave back a lost hope. But it is important that the information on the subject is transparent, real, true ”. Thus, Amadori recalls, it is good to remember that CAR-T – which today boast hundreds of experiments around the world, on different types of cancer – are currently a therapeutic option for only some types of blood cancer (lymphoblastic leukemia acute, some types of lymphoma and multiple myeloma) that have not responded to other therapies. Others are likely to arrive, perhaps even with T cells from donors, explains Amadori: “Yes, it is a revolutionary therapy, but it still needs to be refined”. Not only in terms of efficacy – although in some cases for leukemias and lymphomas, remember the president, there is talk of a complete remission of 60-70% – but also in the management of side effects, or in their administration.
And for this reason – to talk about the real promises and expectations on CAR-T, their fields of application and their limits, the centers that can provide them – AIL has launched the “CAR-T Future Destination” campaign created with non-conditioning support. by Celgene (now part of Bristol Myers Squibb), Gilead, Janssen and Novartis. Face-to-face events, with the participation of AIL and the hematologists who work in the centers that deliver the therapies, and an online information campaign (on the AIL website), will try to respond to this need for clear and transparent information. Also from a historical and research point of view, thanks to the video-story starring Andrea Grignolio, professor of History of Medicine and Bioethics at the S. Raffaele University of Milan – CNR Ethics.
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