Cancer patients in Louisville, in Kentucky and throughout the region soon will have access to some of the most advanced immunotherapy treatments available. Louisville resident Thomas E. Dunbar has pledged $1 million to the University of Louisville to create a specialized center to provide chimeric antigen receptor positive T (CAR T) cell therapies to patients at the UofL Brown Cancer Center and other centers in Kentucky and the Midwest. The new program will be named the Dunbar CAR T-Cell Program.
“This gift will allow both kids and adults to be treated right here in Kentucky with the most innovative cell-based immunotherapy being developed,” said Jason Chesney, M.D., Ph.D., director of the UofL Brown Cancer Center.
In CAR T-cell therapies, immune cells are extracted from the patient’s own blood and then are genetically modified to fight cancer. The modified cells are infused back into the patient where they fight the cancer and create long-term immunity to its recurrence. In addition to dramatic treatment results, CAR T-cell immunotherapy leads to fewer toxic side effects than traditional chemotherapy.
“Patients who have been treated with all the conventional therapies who then underwent treatment in clinical trials with CAR T cells had dramatic response rates. Eighty-three percent of kids in the original trial who had lethal, terminal B-cell acute lymphoblastic leukemia responded to this therapy,” Chesney said.
CAR T-cell therapy is FDA approved for treating patients who have B-cell acute lymphoblastic leukemia, who are mostly children, as well as adults who have an adult form of a B-cell (non-Hodgkin’s) lymphoma. This technology also is being tested for treatment of other cancers through clinical trials. Until now however, these treatments have been available primarily in larger coastal cities outside of the Midwestern United States.
“At the UofL Brown Cancer Center, we feel strongly that these advanced therapies should be available not just to people in New York or California or Texas, but to people in Kentucky, Indiana, Tennessee and Illinois. If you live in these areas, it is going to be very hard for you to be treated a thousand miles away with a therapy like this,” Chesney said. “And any patient with health assistance through Medicaid is likely to be covered only if the treatment is delivered within the state.”
The Dunbar CAR T-Cell Program will include laboratories for manufacturing the CAR T cells and will administer both FDA-approved and clinical-trial therapies to adult and pediatric cancer patients. The program intends to expand clinical trials and clinical research using CAR T-cell therapy to treat additional cancer types in Louisville. The goal is for the facilities to be fully functional and receiving patients by Sept. 30, 2020.
Tom Dunbar’s son, Evan, lost his battle to cancer with neuroblastoma in 2001 at the age of 6. In 2009, Wally Dunbar, Tom Dunbar’s father, lost his battle with melanoma. This year, Tom’s physician wife, Stephanie Altobellis, M.D., helped identify his own cancer.
“Kentucky is at ground zero, with the nation’s highest rates of cancer diagnosis and death,” Tom Dunbar said. “It’s completely unacceptable. We have to lead the charge right here where the need is the greatest and we can do the most good. We need treatments that are not toxic. Watching our loved ones miserable with pain, often just from the treatments, and yet still die in front of us simply can’t be the best that we can do.”
How CAR T cells work
T cells are key immune cells in the body that attack cancer cells. CAR T cells are T cells that have been isolated from the patient’s blood and then genetically modified to more effectively destroy the cancer cells.
A non-infectious virus is used to insert genes into the T cells that express a receptor specific to proteins, or antigens, present on cells of the cancer to be treated. The armed, loaded T cell is drawn into close proximity to the cancer cell, and the new cell sends a signal for the T cell to kill the cancer cell.
“We add the receptor gene into the T cells, which makes them stick to the cancer cells like Velcro,” Chesney said. “In theory, all cancers have unique antigens on their surface that we can target with this approach. We are nudging the immune system on to really hit the target, in this case the cancer cells.”
The sophisticated technology requires the use of a specialized clean room for genetically manipulating the patients’ immune cells. The clean rooms, known as Good Manufacturing Practice (GMP) laboratories, require specialized documentation and equipment to protect the individuals working there and ensure a sterile and controlled environment for the cells.
The Dunbar CAR T-Cell Program will include two GMP laboratories, one for use in pediatric therapies to be named for Evan Dunbar and one for adult therapies to be named for Altobellis. These labs are intended to support not only clinical trials and patient treatment at the UofL Brown Cancer Center, but also in other health centers in Louisville, Lexington and elsewhere.
“Our goal for the Dunbar CAR T-Cell Program GMP labs is to be a hub manufacturing facility for CAR T cells, not just in Kentucky, not just in the region, but for the entire country,” Chesney said.
For Dunbar, the goal is to improve cancer treatment for patients.
“The burden is on each of us to create a better future for our children,” Dunbar said. “Working together, we can ensure Louisville is equipped to provide the durable cures, free of side-effects, that we desperately need.”