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Cellular Therapy at UK Markey Cancer Center · UK HealthCast

• 0:00
  Scott Webb (Host): Welcome to UK HealthCast, a podcast from UK Healthcare.
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  I'm Scott Webb.
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  And today, we're going to learn about cellular therapy in cancer
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  treatment from the Chief of Hematology and Cellular Therapy at
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  the UK Markey Cancer Center, Dr.
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  Pierluigi porcu.
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  Doctor, it's nice to have you here today.
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  We're going to talk cellular therapy and what that means exactly.
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  So, what is cellular therapy, and what makes it such a transformative
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  area in oncology today?
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  Dr. Pierluigi Porcu:
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  So, cellular therapy essentially is a form of therapy for diseases that span
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  from cancer to autoimmune diseases, neurological diseases, and fundamentally
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  is based on the fact that we're using human live cells for our treatment goal.
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  These cells, most of the times, are taken from the patient themselves, so
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  they are so-called autologous cells.
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  They are modified very often in a variety of different ways, and then they are
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  infused back into the patient where, first, they grow, so they expand—so, these
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  are live medicines that grow into the patients over a period of several weeks.
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  And they find their target, whether it's a cancer cell or it is the
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  cells that are triggering some of the autoimmune responses, and they
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  target them, and they clear them.
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  And the effect is durable because these cells that are infused back, they tend
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  to stay in the body for an extended period of time, sometimes years.
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  Host: Okay.
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  Yeah, it's very interesting and wondering maybe how the new cellular therapies
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  help patients whose cancers have not responded to existing treatments.
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  Dr. Pierluigi Porcu:
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  Yeah, it's just like for any therapy with the development of cell therapy,
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  for example, something called CAR T cells, which was the first really type
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  of engineered cell that was developed.
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  Initially, those treatments were reserved for patients who had failed most of their
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  standard of care therapies, and they had no other option, or they had lost hope,
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  and their cancer was not responding.
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  And that's where the value of this therapy really proved itself by
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  producing responses that, you know, candidly were really completely
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  unexpected in giving hope to patients.
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  Just like for any other therapy, as we learn more about the safety, right, and
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  the specifics of how these cells really persist in the body and they evolve.
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  And once safety and efficacy is demonstrated, then these therapy are
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  moved back upfront because there may be patients with cancers that are difficult
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  to treat from the very beginning, not necessarily after having failed, you
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  know, multiple different treatments.
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  Host: Sure.
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  Dr. Pierluigi Porcu:
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  That's what happened over the past, you know, 10 to 15 years, and
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  those therapies have been moved up.
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  Host: Yeah, I can remember doing podcasts on CAR T cell and immunotherapy, and
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  now add cellular therapy to this.
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  You know, it makes me wonder, you know, when we think about the just sort of
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  understanding, if you will, immune cell development and dysfunction, why it's
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  so important for folks like yourself to create better cancer treatments.
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  Dr. Pierluigi Porcu:
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  Yeah.
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  One of the interesting things about cell therapy is the fact that it
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  really sort of uses a mechanism to fight disease, cancer in particular,
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  that is completely different from what the conventional chemotherapy.
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  And, you know, cancers are smart.
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  They tend to develop resistance to the treatments that they are exposed to.
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  And this gives us the opportunity to attack the cancer from a
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  completely different angle.
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  So, this is really kind of the advantage and the game-changer
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  effect that these therapies have.
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  Now, cell therapy evolved from a fairly old type of treatment that is what used to
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  be called the bone marrow transplantation, now it's called stem cell therapy.
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  And that was a relatively primitive, I would say, way of
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  actually doing cell therapy.
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  It was working, but it was nonspecific.
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  The game-changer really was the fact that now we're developing personalized
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  therapies for the specific patient that we have, that we see in the clinic.
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  And patients get their specialized, specific, personalized treatment for them.
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  That's really sort of the revolution that cell therapy has brought.
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  Host: Yeah.
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  Yeah, as you say personalized, it made me think, you know, maybe what message
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  you'd want to share with patients, families, communities across Kentucky
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  about the future of cancer care.
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  Dr. Pierluigi Porcu:
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  Absolutely.
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  I mean, I think that one of the things that we have learned and slowly made
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  progress on is the fact that every patient is different, every cancer is different.
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  And therefore, sort of, you know, catch-all, fits-all kind of solutions,
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  even though was the only thing that was available many, many years ago,
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  are really not the best way to go.
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  And one is because they often are not effective, and the other is
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  that they often cause significant amount of, you know, side effects.
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  And so, the personalized approach here is the fact that, number one,
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  we're using the patient-owned cells to really sort of build kind of the
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  strategy for treatment and build a product that is going to be reinfused.
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  And because the mechanism is different, I think we have a better
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  chance of this therapy working.
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  In the course of that, that's also part of the scientific revolution
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  that cell therapy has produced.
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  In the course of that, we're learning a lot about the patient's own
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  specific immune system, because as I said, every patient is different.
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  Some patients are younger, some patients are older, some
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  patients are more ill than others.
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  And when we take their cells and we train them to actually recognize
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  the cancer, we have learned that not every patient is producing a
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  product that is equally efficient.
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  So, some patients, it will be more challenging for them and for us
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  to produce a cell therapy product that is effective for them, right?
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  And we're learning, you know, what is driving those differences.
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  And now, more importantly, we're learning how to modify those differences, so
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  that both in vivo, so both, you know, in the patient himself or herself, as
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  we prepare them to get the collection of the cells, but also in vitro, so in other
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  words, in the laboratory, how to actually can modify those cells and make them
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  smarter, make them more powerful, expand better, for example, and survive longer.
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  So, all those things are things that we have learned from the
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  very early days of cell therapy.
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  Host: Yeah.
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  Doing a lot of head shaking over here.
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  It's just really amazing.
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  As you say, you know, cancer cells are smart.
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  We need to outsmart them and train our cells and put them back into bodies.
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  It's pretty amazing.
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  But, Doctor, you know, I mentioned earlier, you know, immunotherapy, CAR
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  T-cell, we're talking cellular therapy.
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  I'm sure a lot of folks are just wondering, okay, but what
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  does all that mean, right?
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  How would you explain these treatments in, let's call it, everyday language?
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  Dr. Pierluigi Porcu:
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  Of course.
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  There are two ways of approaching that explanation.
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  One is kind of the medical side of it, so the scientific side of it, explaining
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  which kind of cells we're taking, how we're treating them, and, you know,
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  how we are modifying them and so on.
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  The other is the practical side, which is what, you know, for the patient
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  themselves, what actually happens, right?
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  They come to the clinic.
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  So, here's kind of a sequence of events that really, you know, patients who
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  undergo this therapy have to be aware of how it's actually impacting their lives.
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  The patients have to be seen and, you know, their cancer has to be
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  characterized in a very careful way.
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  So, very often, that requires making sure that the pathology and the biopsies
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  are accurate, the diagnosis is correct, and that, you know, there are all
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  the different targets that the cell therapy requires are actually present.
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  And this is done fairly routinely, so this is not in any way experimental.
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  And then, there is actually the logistics of, you know, the patients
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  have to come in, they have to receive some therapy to prepare them
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  for the collection of the cells.
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  And then, they have to spend a day in something called the
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  apheresis section in the apheresis lab, having the cells collected.
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  Then, after that, they can go home.
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  Cells typically take about two to three weeks to be manufactured.
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  And then, they come back two to three weeks later, and they
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  receive the cells in the office.
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  So typically, this is a kind of outpatient ambulatory infusion.
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  We keep ready, of course, and often we have to admit the patient to the
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  hospital because for the initial monitoring, because these therapies
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  tend to cause a lot of inflammation because that's the way they work.
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  So, inflammation is just kind of a byproduct of what
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  we're asking the cells to do.
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  And inflammation can cause fevers, can cause change in your blood pressure.
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  And so, all of those things need to be monitored.
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  We have very specific protocols to deal with that, but that
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  requires quite a bit of time on the part of the patient as well.
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  So, it's a fairly engaging type of initial involvement.
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  However, the beauty of cell therapy is that unlike most other cancer
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  therapies that you need to come back off and on, off and on for multiple
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  infusions, it only happens once.
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  So, this is all given once.
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  Host: Right.
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  It seems to me, Doctor, you know, we don't get where we are, we don't
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  get to have conversations like this without the clinical trial.
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  So, just wondering, you know, what opportunities do you see, you know,
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  to expand the clinical trials at the UK Markey Cancer Center, and
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  how maybe folks could get involved?
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  Dr. Pierluigi Porcu:
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  Yeah.
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  So, that's actually a fantastic question, because one thing that often is not
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  emphasized enough is the fact that all these wonderful therapies that we have
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  in the clinic, standard of care available to everybody who's eligible for it,
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  these therapies were developed and are here now because there was clinical
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  research that initially was invested in the development of those therapies.
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  So, clinical trials are essentially the conduit, are the foundation
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  for everything, every cancer therapy that we give today.
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  We are giving it because there were clinical trials that sort of helped
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  with their development and established essentially the knowledge base, the safety
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  information, and also kind of what we call the regulatory, you know, approvals from
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  the FDA, for example, and other agencies, to make sure that they actually are used
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  properly and for the right patients.
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  Host: Right.
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  Yeah, this has been so educational.
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  I feel like we could stay on for much longer, but in the interest of
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  time and listeners' attention spans, what factors determine whether a
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  patient can or may be considered for cellular therapy for a clinical trial?
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  Dr. Pierluigi Porcu:
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  A lot of it has to do with the specific of their cancers.
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  And I have to say that one of the big advantages here in Kentucky is
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  the fact that, you know, we have a Markey Cancer Center that is an
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  NCI-designated comprehensive cancer center, so it's the elite essentially
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  of the cancer centers across the nation.
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  And therefore, clinical trials really are a primary mission for the
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  cancer center serving essentially the population of Kentucky.
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  So, Kentuckians across the state really have the opportunity to have access to
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  therapies that no one else really has access outside of clinical trials, and
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  we have these clinical trials here.
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  This includes things from, you know, very common cancers here in Kentucky, lung
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  cancer, for example, gastrointestinal cancer, colon cancer, you name it.
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  And then, of course, for all the blood cancers that have been,
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  you know, in the front end of the development of these therapies.
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  And so, the advantage is really the fact that people don't have to
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  travel outside of the state to have access to these clinical trials.
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  We can do them right here in Lexington at Markey.
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  Host: Never a good time to have cancer, Doctor, of course.
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  But all the tools you have in your toolbox there and the clinical
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  trials, lots of reason for optimism.
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  I'm sure you share that.
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  So, I appreciate your time and your expertise today.
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  Thanks so much.
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  Dr. Pierluigi Porcu:
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  Scott, thanks.
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  It was great to be with you.
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  Host: And for more information, visit markey.uky.edu.
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  And that wraps up another episode of UK HealthCast from UK Healthcare.
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  Please remember to subscribe, rate, and review this podcast and all
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  the other UK Healthcare podcasts.
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  I'm Scott Webb.
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  Stay well.