Cancer remains one of the significant challenges in modern medicine. The prospect of cell therapy for cancer is promising, with advances in technology expected to enhance precision and treatment success rates.Immunotherapy is a revolutionary approach to cancer treatment, utilizing the patient’s own immune cell system to combat tumors. Among these, CAR-T cell therapy stands out as one of the most prominent in recent clinical anticancer performance.
1.Currently, there are three directions in new cancer therapies: personalized medicine, immune cell therapy, and precision medicine.
A.Personalized Medicine
Through genetic testing and drug combinations tailored to the patient’s genetic abnormalities, treatment can be optimized to maximize efficacy, minimize damage to normal body cells, reduce treatment risks, and avoid the use of ineffective drugs. This approach ultimately improves cancer survival rates and quality of life for patients.
B.Immune Cell Therapy
Enhancing the patient’s own immune system to actively attack and destroy cancer cells is the essence of immunotherapy. Compared to traditional chemotherapy or radiation therapy, immunotherapy offers long-lasting effects, reduces the risk of cancer recurrence, and minimizes side effects.
By extracting the patient’s own immune cells, processing them, and then reintroducing them into the body, the immune system is stimulated to fight against cancer cells. Additionally, immunotherapy can be applied to various types of cancers, including but not limited to breast cancer, colorectal cancer, and melanoma, thus offering broad prospects for application.[1]
C.Precision Medicine
By collecting and analyzing patients’ clinical data, utilizing big data and artificial intelligence technologies, we can predict the effectiveness of cancer treatments and provide the most suitable treatment plans. This approach maximizes treatment success rates while reducing time and money wasted during treatment, thus enhancing the overall treatment experience for patients.
Through precise predictions, doctors can tailor more accurate treatment plans based on individual differences and cancer characteristics, thereby improving treatment effectiveness and durability. This personalized approach not only helps patients better cope with cancer but also saves resources and improves efficiency within the healthcare system.
2.One of the new trends in cancer treatment: Immunotherapy.
Immunotherapy[2]is a revolutionary cancer treatment method that harnesses the patient’s own immune cell system to combat tumors. Among these, CAR-T cell therapy stands out prominently.
Chimeric Antigen Receptor T cell (CAR-T) therapy combines the characteristics of immunotherapy, cellular therapy, and gene therapy. It has shown considerable success, particularly in treating refractory and relapsed diffuse large B-cell lymphoma and pediatric B-cell acute lymphoblastic leukemia. This therapy involves collecting the patient’s T cells, genetically engineering them in the laboratory to express a specific gene called CAR, which enables the T cells to recognize cancer cells (thus termed CAR-T cells), and then reintroducing them into the patient’s body.
Like a specialized unit armed with potent weapons, these modified CAR-T cells possess enhanced tumor recognition and killing abilities. As they are autologous live cells, once infused back into the patient’s body, they start proliferating continuously, enabling sustained surveillance to eliminate residual cancer cells, greatly reducing the risk of recurrence while preserving other normal organs or cells. This is a critical aspect in cancer treatment.
In addition to CAR-T cell therapy, immunotherapy also encompasses other methods such as T cell therapy and Natural Killer (NK) cell therapy. T cell therapy involves harvesting the patient’s T cells, expanding them in vitro, and then reinfusing them into the patient’s body. These specific T cells can identify and attack tumor cells, triggering an immune response and inhibiting tumor growth. On the other hand, NK cell therapy utilizes the natural killer cells’ ability to directly kill tumor cells, achieving therapeutic effects.
3.CD19 CAR-T cell therapy has been included in the “Conditional Health Insurance” coverage.
In 2012, a young girl named Emily in the United States became the first child globally to undergo CD19 CAR-T cell therapy after being diagnosed with acute lymphoblastic leukemia. After ten years of continuous monitoring, current examination results show no signs of recurrence or traces of cancer cells in her body, indicating complete eradication.
In April 2022, National Taiwan University Hospital (NTUH) became the first medical center in Taiwan to officially provide CAR-T therapy. With the assistance of NTUH, Taiwan saw its first girl, Ting Ting, receiving formal CD19 CAR-T cell therapy. Ting Ting, initially hospitalized for pediatric B-cell acute lymphoblastic leukemia, has now fully recovered under the treatment and care provided at NTUH[3].
Previously, the cost of such cell therapy was considerably high. However, in November 2023, the Taiwan National Health Insurance Administration announced the inclusion of CAR-T cell therapy under conditional health insurance. As long as patients under 25 years old meet the criteria of “acute lymphoblastic leukemia” or “diffuse large B-cell lymphoma” and show poor response or relapse after two lines of standard treatment (usually ineffective after the first round of chemotherapy, followed by a second round of drugs or radiation therapy or ineffective autologous or allogeneic stem cell transplantation), they may qualify for health insurance coverage.
This significantly improves the accessibility of CAR-T cell therapy and provides an opportunity for patients who couldn’t afford the expensive treatment before to strive for long-term survival or even cure in the late stage of cancer. It is estimated to benefit nearly a hundred patients with acute lymphoblastic leukemia or diffuse large B-cell lymphoma each year.
4.The outlook for CAR-T cell therapy is promising, and advancements in technology will enhance precision and treatment success rates.
In Taiwan and globally, medical institutions and research teams are tirelessly promoting immunotherapy, bringing hope and improving the quality of life for patients. Laboratory research continuously enhances immunotherapy techniques to ensure their success in practice, aiming to eliminate cancer cells and reduce recurrence rates.
In the past, cancer treatment heavily relied on chemotherapy, radiation therapy, or targeted drugs, which often caused considerable damage to patients’ normal cells. Side effects such as hair loss, vomiting, rapid weight loss, and increased susceptibility to viruses and bacteria posed additional risks of complications, not to mention the impact on quality of life[4].
With technological advancements, CAR-T cell therapy will become more precise, effectively targeting tumor cells and increasing cancer cure rates. Clinical trials will deepen our understanding of the effectiveness and safety of immunotherapy methods, enabling further personalized treatments to reduce side effects and increase success rates.
With a deeper understanding of CAR-T cell therapy, it is expected to treat more types of cancer, autoimmune diseases, and infectious diseases. This technology will also be combined with other treatment methods to provide patients with more comprehensive treatment plans, ultimately improving survival rates and quality of life.
References
- Getting to know the new medical techniques “cell therapy” and “gene therapy”: What policy support is still needed for their development in Taiwan?, PanSci, 03/08/2020
- What is cell therapy, Ministry of Health and Welfare
- Taiwan’s version of Emily! National Taiwan University’s “CD19 CAR-T cell therapy” helps leukemia girl regain new life, Health Medical Network, 19/07/2022
- The Navy SEALs of Cancer Treatment: A Brief Discussion on CAR-T Cell Therapy, Taiwan Cancer Foundation