Cancer research has made significant strides in recent years, particularly in immunotherapy. CAR-T (Chimeric Antigen Receptor T-cell) therapy stands out for its remarkable ability to treat previously untreatable cancers among the various immunotherapy options.
This innovative approach has transformed the treatment landscape for blood cancers like acute lymphoblastic leukemia and multiple myeloma. The foundation of CAR-T treatment was laid by Prof. Zelig Eshhar in 1989, whose groundbreaking work has paved the way for its development.
Several CAR-T products have received FDA approval to treat relapsed or refractory B-cell lymphoma and other common malignancies in children and adults.
What Is CAR-T Therapy?
CAR-T cell therapy is an immunotherapy that utilizes a patient’s T-cells to combat cancer. The process involves:
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Extraction of T-cells from the patient’s blood.
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Genetic Modification of these cells with a chimeric antigen receptor (CAR).
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Reintroducing the Modified T-cells back into the patient's bloodstream.
This modification allows the T-cells to recognize and attack malignant cells that would otherwise evade detection by the immune system. T-cell treatment has shown particular effectiveness in treating:
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Large B-cell lymphoma;
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Multiple myeloma.
CAR T-cell therapy offers hope for patients who have not responded to traditional treatments and has been a significant breakthrough in oncology.
What Are the Benefits of CAR T-Cell Therapy?
The success of CAR-T therapy in treating blood cancers has been remarkable, with many patients achieving complete remission after being resistant to other treatments. Key benefits include:
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High Precision Targeting. CAR T-cell therapy targets explicitly cancer cells using the patient’s immune system.
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Personalized Approach. Because it is based on the patient's white blood cells, it may reduce side effects compared to conventional treatments like chemotherapy.
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Hope for Limited Options: CAR-T treatment provides a promising option for patients who have exhausted other treatment avenues.
However, it’s important to note that CAR-T therapy can be expensive. In Israel, the minimum cost for treatment is around $90,000 per infusion, not including additional expenses like travel and accommodation.
What Are the Challenges of CAR-T Therapy?
Like any medical treatment, CAR-T therapy comes with potential side effects, the most common of which include:
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Cytokine Release Syndrome (CRS) can cause symptoms such as fever, nausea, and low blood pressure due to the immune system becoming overly active.
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Neurological Effects:. Some patients may experience confusion or seizures, though these side effects are typically temporary and manageable.
While these side effects require close monitoring for at least three weeks, they are generally reversible.
How Does CAR-T Therapy Work?
The CAR-T treatment process modifies a patient's T-cells to target blood cancer specifically and generally involves the following steps:
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Leukapheresis. Collecting of immune system cells from the patient.
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Sending cells to the lab for genetic modification;
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Enabling T cells to produce chimeric antigen receptors (CARs) that identify cancer markers;
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Cell Growth. Growing millions of the modified T-cells.
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Re-infusion. Infusing the CAR-T cells back into the patient's bloodstream.
The CAR helps the immune cells recognize specific proteins, like CD19, allowing them to destroy damaged cells while sparing healthy tissue. Unlike traditional treatments, CAR-T therapy utilizes the patient's immune system for a more targeted approach, potentially reducing side effects.
How to Prepare for a CAR T-Cell Therapy?
The preparation process for CAR T-cell therapy typically involves several key steps:
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Comprehensive Evaluation. A thorough evaluation assesses the patient's eligibility for CAR T-cell therapy. This includes a detailed medical history and other tests to identify potential contraindications.
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Blood Draws. Multiple blood samples are collected to assess the immune system function.
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Physical Examinations. Regular physical examinations help to detect any changes that may interfere with the treatment plan.
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Pre-Treatment Medications. Sometimes, patients may receive pre-treatment medications to enhance the impact of CAR T cells and reduce the quality of side effects. This includes lymphodepleting chemotherapy or corticosteroids.
How Is CAR T-Cell Therapy Different From Other Treatments?
Here's an overview of CAR T-cell therapy's pros and cons compared to other treatments.
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Treatment Type |
Pros |
Cons |
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- Personalized, uses patient's own T-cells. - High precision targeting of cancer cells. - Long-term remission potential, especially for blood cancers. - Promising for treatment-resistant cancers. |
- Personalized, uses patient's own T-cells. - High precision targeting of cancer cells. - Long-term remission potential, especially for blood cancers. - Promising for treatment-resistant cancers. |
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- Effective for a wide range of cancers. - Often used as a first-line treatment. |
- Significant side effects (nausea, fatigue, hair loss). - Non-specific targeting—damages healthy cells. - Risk of drug resistance developing over time. - Immune suppression. |
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Radiation therapy |
- Targets specific areas of the body. - Useful for localized tumors. - Non-invasive, outpatient treatment. |
- Can damage surrounding healthy tissues. - Side effects like fatigue, skin irritation. - Limited efficacy for widespread or metastasized cancer. - Risk of long-term complications (e.g., secondary cancers). |
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- Targets specific molecules or pathways in cancer cells. - Fewer side effects compared to chemotherapy and radiation. - Often used in combination with other treatments. |
- Only effective for cancers with specific genetic mutations. - Cancer cells may develop resistance. - Can still cause side effects (e.g., fatigue, skin issues). - Not suitable for all cancer types. |
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Immunotherapy (other types) |
- Boosts the body’s immune system to fight cancer. - Long-lasting effects possible. - Potentially fewer side effects than chemotherapy. |
- Effectiveness varies among patients and cancer types. - Risk of immune-related side effects (e.g., inflammation, autoimmune issues). - Requires careful patient monitoring. - High cost, depending on the therapy. |
Why Choosing Israel for CAR T-Cell Therapy?
The Israeli healthcare system fosters collaboration among researchers and clinicians, driving innovation in CAR T-cell therapy. This collaborative environment leads to:
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New treatment approaches;
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Improved outcomes;
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Enhanced patient care.
For CAR T Therapy, Israel is one of the top patient choices. It offers plenty of essential benefits, such as:
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World-Class Medical Institutions: Israel's medical professionals have over 30 years of experience in CAR T-cell therapy.
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Innovative Research. The local researchers are at the forefront of CAR T-cell therapy advancements, constantly refining existing techniques.
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Competitive Pricing. The CAR T-cell therapy in Israel is relatively more affordable than in other countries (twice the price of most UK hospitals and a quarter of the cost compared to Spanish centers)
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Strategic Location. Israel's central location makes it easily accessible for medical tourists from various continents.
What Is the History of CAR T Therapy in Israel?
Israel has been a pioneer in CAR-T cell therapy, starting from the research done in the 1980s and 1990s. Since 2015, Sheba Medical Center has achieved outstanding results with CAR-T therapy, treating over 250 patients and achieving about 75% complete remission rates. This success has positioned Sheba as a global leader in CAR-T treatment.
Other hospitals in Israel, such as Sourasky Medical Center, also offer CAR-T therapy and contribute to ongoing research to enhance its effectiveness. As a result, Israeli hospitals are becoming a leading choice for cancer patients worldwide seeking cutting-edge treatment.
Israel's achievements in CAR T-cell therapy have garnered international recognition. The country's expertise and success in this field have attracted patients from around the world seeking advanced treatment options. Israeli hospitals are increasingly seen as destinations of choice for those battling blood cancers.
Who Are the Pioneers of CAR-T Therapy in Israel?
Israel has played a crucial role in the development of CAR-T treatment. Prof. Zelig Eshhar first engineered T-cells in 1989, leading to the development of CAR-T therapies like Kymriah and Yescarta, which target CD19 found in B-cell lymphoma.
In recent years, prof. Arnon Nagler, the President of the Hemato-Oncology Center at Sheba, is known for his work in stem cell transplantation and CAR-T cell therapy.
Professor Nagler's medical team is successfully producing CAR T-cells for all patients treated. The average time from the patient’s first visit to the infusion of the CAR T-cells is about 11 days, which is quite efficient.
The other encouraging aspect of his research is the low side effects. This is particularly encouraging for multiple myeloma patients, as other cancer types don't report as many side symptoms after treatment.
What to Consider Before Choosing CAR T Cells in Israel?
While Israel offers many advantages for CAR T-cell therapy, it's essential to consider the following factors:
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Costs. Although the price of CAR T cell treatment in Israel is affordable, the patients should consider additional expenses. These include travel and lodging, plus possible out-of-pocket costs for medical services.
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Insurance Coverage. Check with your insurance provider to determine the extent of coverage for CAR T-cell therapy in Israel.
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Visa Requirements. Ensure you fill out the necessary paperwork for undergoing treatment abroad.
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Language. While many medical professionals in Israel speak English, it's helpful to understand the language or arrange for a translator.
Bookimed coordinators will be happy to help with any of the aforementioned costs. If you feel lost about finding the right hospital or a doctor in Israel, just fill out an application for us to arrange a treatment strategy.
References
CAR-T cell therapy in Sheba: overview of activity– Prof. Arnon Nagler. Sheba Government Hospital, Israel. URL: https://eng.hospital-direct.org.il/car-t-cell-therapy-sheba-overview-activity-prof-arnon-nagler-part-2.aspx (date of access 27.09.2024)
CD19 car T-cell therapy in autoimmune disease — a case series with follow-up. New England Journal of Medicine, 390(8), 687–700. URL: https://www.nejm.org/doi/full/10.1056/NEJMoa2308917 (date of access 27.09.2024)
Childers L. Preparing Patients for CAR T-Cell Therapy With Confidence. Oncology Nursing News. URL: https://www.oncnursingnews.com/view/preparing-patients-for-car-t-cell-therapy-with-confidence (date of access: 27.09.2024).