Mocht u de informatie op kanker-actueel waarderen dan wilt u misschien ons ondersteunen met een donatie. We zijn en blijven een ANBI organisatie, ook in 2019 dus uw donatie is in principe aftrekbaar voor de belastingen. Ook kunt u korting krijgen bij verschillende bedrijven op voedingssupplementen.

27 december 2018: Bron: JAMA

In gerelateerde artikelen staan enkele studiepublicaties met CAR-T cel therapie. En allemaal geven ze hele goede resultaten bij verschillende vormen van kanker. In JAMA verscheen een overzichtstudie over de stand van zaken van CAR-T celtherapie in de klinische praktijk (toepassing in ziekenhuizen bij kankerpatienten). 

Hier uit die publicatie een grafiek hoe CAR-T cellen werken:

1. Afweercellen (T-cellen) worden bij de patiënt afgenomen via bloed en lymfklieren
2. In het laboratorium wordt een zogeheten CAR = Chimeric Antigen Receptor toegevoegd aan de T-cellen van de patiënt.

De hoop is dan als de T-cellen terug worden gegeven aan de patiënt dat de gemoduleerde T-cellen nu wel de kankercellen herkennen en het immuunsysteem activeren om deze te vernietigen.

Image description not available.

Meestal gaat het wel goed met deze vorm van immuuntherapie en zoals gezegd zijn de resultaten echt hoopgevend. Maar CAR-T cellen kunnen ook ernstige bijwerkingen veroorzaken. Daarom worden CAR-T cellen altijd in het ziekenhuis toegediend waar de patiënt nauwlettend kan worden gevolgd.

Een van de bijwerkingen die vaak optreden is dat een patiënt lagere waarden van witte bloedlichaampjes krijgt, met als gevolg ernstige vermoeidheid en grotere kans op infecties. Soms is zelfs een bloedtransfusie nodig. 

Bij sommige patiënten kunnen ook normale immuuncellen, de zogenoemde B-cellen, worden aangetast, Als dat geberut wordt dit  B-celaplasie genoemd. Omdat B-cellen normale antilichamen aanmaken om mensen tegen infecties te beschermen, moeten mensen met B-celaplasie antistoffen krijgen die periodiek intraveneus worden toegediend.

Daarnaast zijn er nog twee 2 effecten die ernstig kunnen zijn na een behandeling met CAR T-celtherapie, Dat zijn het zogeheten cytokine-release syndroom (CRS) en neurologische complicaties. 
Patiënten met CRS ontwikkelen doorgaans koorts, uitslag, hoofdpijn en veranderingen in de bloeddruk. De symptomen van neurologische toxische effecten variëren van hoofdpijn tot verwarring, delirium en toevallen.

Hoewel deze symptomen zich snel na toediening van de CAR-T cellen kunnen voordoen en ze ook wel beheersbaar zijn als er op tijd ingegrepen wordt zijn er ook enkele gevallen bekend waarbij die bijwerkingen pas later optraden.

De mogelijke nadelige effecten van CRS kunnen zijn cardiale disfunctie, bloedingen en nier- en / of leverfalen. Het beheersen van ernstige CRS of neurotoxische effecten kan het gebruik van specifieke medicijnen met zich meebrengen om deze symptomen het hoofd te bieden.

Zie verder in gerelateerde artikelen enkele studiepublicaties.

Het artikel in JAMA: Chimeric Antigen Receptor (CAR) T-Cell Therapy is tegen betaling of als u een registratie doet te downloaden.

Voor meer informatie over CAR-T celtherapie klik op de volgende links:

Hier het abstract van de studie uit JAMA:

JAMA Oncology Patient Page
November 2017

Chimeric Antigen Receptor (CAR) T-Cell Therapy

JAMA Oncol. 2017;3(11):1595. doi:10.1001/jamaoncol.2017.2989
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Articles

CAR T-cell therapy uses the patient’s own immune cells to personalize cancer immunotherapy.

What Is CAR T-Cell Therapy?

CAR T-cell therapy is a cancer treatment that uses a patient’s own immune system cells, called T cells, after these cells have been modified to better recognize and kill the patient’s cancer. The T cells are engineered in the laboratory and then expanded to large numbers and infused back into the patient. This type of treatment transfers an immune system into the patient that is capable of immediately killing the cancer. CAR stands for chimeric antigen receptor, which represents the genetically engineered portion of the T cell. The CAR part of the T cell contains proteins that allow the T cells to recognize the specific cancer cells as well as become highly activated to kill the cancer cells.

Once in the body, the CAR T cells can further grow to large numbers, persist for long periods of time, and provide ongoing tumor control and possible protection against recurrence.

How Are CAR T Cells Made for Each Individual Patient and Administered?

The first step is to collect the patient’s T cells from their blood using an outpatient procedure known as leukapheresis. These T cells are shipped to the laboratory for modification and manufacturing. The CAR-containing T cells are then returned for reinfusion into the patient. This process takes about 2 weeks. During the time that the cells are being developed, the patient will typically receive specific chemotherapy that can help prepare the immune system to support the CAR T cells once they are given back to the patient.

Possible Adverse Effects of CAR T-Cell Therapy

CAR T cells are administered in the hospital, where the patient can be monitored closely. Patients receiving CAR T-cell therapy typically develop temporarily low blood cell counts from the treatment, with fatigue, risk of infection, and need for transfusion support. Some patients may also have some of their normal immune cells, called B cells, destroyed as bystanders of the treatment, causing a condition called B-cell aplasia. Because B cells normally make antibodies to protect people from infections, people with B-cell aplasia need to have antibodies periodically given by vein.

In addition, there are 2 significant adverse effects that can occur after CAR T-cell therapy, both potentially serious: cytokine release syndrome (CRS) and neurologic complications. Patients with CRS typically develop a fever, rash, headache, and changes in blood pressure. The symptoms of neurologic toxic effects range from headaches to confusion, delirium, and seizures. Though the onset of the symptoms can occur within minutes or hours, they can be seen days to weeks later. The adverse effects are usually reversible, but rare cases of long-term symptoms have been noted. The possible long-term adverse effects may include cardiac dysfunction, bleeding, and kidney and/or liver failure. The management of severe CRS or neurotoxic effects may involve the use of specific drugs to reverse these symptoms.

Current Role

CAR T-cell therapy has received preliminary approval for treatment of children and young adults with a specific form of leukemia that has not been cured with initial chemotherapy treatment. It is being studied in many other cancer treatment settings and may become more widely used based on the results of ongoing clinical research.

Section Editor: Howard (Jack) West, MD.
The JAMA Oncology Patient Page is a public service of JAMA Oncology. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA Oncology suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call (312) 464-0776.
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Article Information

Published Online: September 7, 2017. doi:10.1001/jamaoncol.2017.2989

Conflict of Interest Disclosures: None reported.

 

References CAR-T cel therapy for solid tumors

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