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Chimeric antigen receptor T cell immunotherapy (CAR-T), as a new type of precision targeted therapy for tumor treatment in recent years, has achieved great success in the treatment of hematological tumors
.
At present, global CAR-T clinical trials are in full swing, and new CAR-T drugs are also on the market in China
.
Recently, the CAR-T product targeting CD19, Rigi Orenza, has passed the review of China National Medical Products Administration (NMPA), and has been officially approved for marketing, and has been launched in many provinces and cities across the country.
Issue the first batch of prescriptions
.
On this occasion, Yimaitong sincerely invites Professor Lin Tongyu from Sichuan Cancer Hospital to accept an interview to share his clinical experience in CAR-T treatment
.
Yimaitong: Sichuan Cancer Hospital, as the first batch of prescription hospitals for WuXi Junuo’s CAR-T product, Ruiji Orenza injection, can you talk about your feelings? Professor Lin Tongyu is honored that Sichuan Cancer Hospital has become the first batch of prescription hospitals for WuXi Juno’s CAR-T product Ruiji Oranxel injection.
Thanks to my team and WuXi Juno for allowing our patients CAR-T treatment was carried out in the shortest time
.
I am a double-employed doctor at Sun Yat-sen University Cancer Hospital and Sichuan Cancer Hospital.
Many years ago, I have done many CAR-T clinical trials in Sun Yat-sen University Cancer Hospital
.
CAR-T is an immunotherapy, which is indeed effective for some patients.
Currently approved in China is relapsed or refractory large B-cell lymphoma (R/R LBCL), which is used in relapsed or refractory aggressive B-cell non- The complete response rate (CR) in Hodgkin’s lymphoma (B-NHL) patients is 40%-54%
.
Yimaitong: What are your prospects for cellular immunotherapy represented by CAR-T therapy? What are the prospects for individualized treatment and precision treatment in the field of hematological tumors in the future? Professor Lin Tongyu Actually, the concept of immunotherapy appeared as early as 100 years ago.
The interferon and interleukins used to treat tumors in the 1990s were all immunotherapy
.
Nowadays, high-dose interferons and interleukins still occupy a place in the treatment of tumors such as kidney cancer and malignant melanoma.
However, due to the high dose of the drug, the toxic and side effects are more obvious
.
At present, the generally accepted concept of immunotherapy should be popularized when the US FDA approved the first immunosuppressant ipilimumab in 2011
.
Because of its unique mechanism of action, immunotherapy has brought great changes to tumor treatment, overturned the thinking of tumor treatment in the past, and promoted the progress of tumor treatment
.
Since the US FDA announced that CAR-T was approved for marketing in 2017, CAR-T has been used in relapsed or refractory acute lymphoblastic leukemia (ALL), R/R LBCL, relapsed or refractory mantle cell lymphoma (MCL), and Treatment of relapsed or refractory multiple myeloma
.
This means that CAR-T also has a place in immunotherapy
.
However, the exploration of cell therapy is still very long, and clinical trials with different targets and different indications have yet to be carried out
.
In short, not all patients are suitable for CAR-T cell therapy
.
It is hoped that with the continuous progress of immunotherapy clinical research, CAR-T therapy can be applied to more cancer types
.
The treatment of hematological tumors has gone through the course of individualized and precise treatment from rough chemotherapy to immunotherapy and targeted therapy
.
After entering the era of targeted immunotherapy, more and more cancer patients have obtained longer survival times through targeted drugs and immunotherapy drugs
.
From CD20 monoclonal antibodies, to small-molecule tyrosine kinase inhibitors (TKI), and antibody-drug conjugates (ADC) such as anti-CD30 vebutuximab, all are leading the development of targeted immunotherapy
.
Targeted therapy and immunotherapy, as today's anti-cancer "sharp", are often presented in a way better than chemotherapy, but the role of chemotherapy cannot be ignored
.
It is foreseeable that the triple therapy of immunotherapy, targeted therapy, and chemotherapy will be the direction of future development
.
Taking targeted therapy as an example, the treatment targets of each patient are different, and target loss is prone to occur during the treatment process
.
At this time, if combined with radiotherapy, chemotherapy and other targets, it can increase the possibility of overcoming resistance
.
I hope everyone can continuously improve the quality of life of patients and prolong their survival period through the combined treatment of immuno-targeted chemotherapy
.
Yimaitong: What are the suggestions for the screening of the population with advantages of CAR-T treatment, the safety management during the treatment process, and the whole process management of CAR-T treatment? For the application of CAR-T, Professor Lin Tongyu has formulated a set of standard operating procedures (SOP).
Only patients who fail the second-line or third-line R/R LBCL can consider using CAR-T therapy, and they must have appropriate indications and sufficient The patient's informed consent
.
During the whole process management, especially the safety management, we should be highly vigilant about cytokine release syndrome (CRS)
.
During the treatment process, all participating doctors, nurses, and all staff should closely observe the patient
.
At the same time, patients should also inform their physical condition in time
.
Only with close cooperation between doctors and patients can the disease be finally overcome
.
Yimaitong: Regarding the specific practice of CAR-T therapy in cancer hospitals, what guidance and suggestions do you have? For the whole process management of CAR-T treatment, what kind of cooperation and cooperation are needed between the various departments of the hospital? Professor Lin Tongyu’s CAR-T treatment should be carried out in the department of hematology, oncology, and cancer hospitals in general hospitals.
Therefore, once a patient is diagnosed with malignant tumors, it is best to go to the department of hematology, oncology or cancer hospitals
.
Moreover, oncologists must be specialized, and hospitals must have strict specialized training and admission systems.
Only doctors who have undergone specialized training can be highly responsible for patients
.
I hope everyone can work together to do a good job in the diagnosis and treatment of patients
.
The whole-process management of CAR-T treatment does require the cooperation of various departments of the hospital, from the diagnosis of the pathology department and imaging department, to the screening of patient indications in the clinical department, to the detection of corresponding indicators in the laboratory, as well as the plasma exchange of the blood bank, and the pharmacy.
The emergency drug procurement, as well as the Department of Neurology and Infectious Diseases, are all critical
.
The whole process management of CAR-T treatment should be a manifestation of the overall strength of the entire hospital
.
In short, cancer treatment not only requires individualized, multidisciplinary comprehensive treatment, but also needs to pool the strength of the team.
I hope that everyone can unite and cooperate to benefit more cancer patients
.
Professor Lin Tongyu, University of Electronic Science and Technology of China Cancer Hospital • Sichuan Cancer Hospital Dean, professor, chief physician, doctoral supervisor, chief expert Professor, chief physician, doctoral supervisor of Sun Yat-sen University Cancer Prevention and Treatment Center, chief expert Chinese Medical Association Oncology Branch Chairman Zhong Zhong Head of the Lymphoma Group of the Oncology Branch of the Medical Association CSCO Rare Tumor Expert Committee Chairman CSCO Melanoma Expert Committee Vice Chairman CSCO China Lymphoma Alliance Vice Chairman China Anti-tumor Drug Safety Management Expert Committee Vice Chairman China Southern Cancer Clinical Research Association (CSWOG) Chairman, National Natural Science Foundation Review Expert, National Committee of Experts on Rational Use of Medicines and National Committee of Experts on Medical Malpractice Original ", we make progress together
.
At present, global CAR-T clinical trials are in full swing, and new CAR-T drugs are also on the market in China
.
Recently, the CAR-T product targeting CD19, Rigi Orenza, has passed the review of China National Medical Products Administration (NMPA), and has been officially approved for marketing, and has been launched in many provinces and cities across the country.
Issue the first batch of prescriptions
.
On this occasion, Yimaitong sincerely invites Professor Lin Tongyu from Sichuan Cancer Hospital to accept an interview to share his clinical experience in CAR-T treatment
.
Yimaitong: Sichuan Cancer Hospital, as the first batch of prescription hospitals for WuXi Junuo’s CAR-T product, Ruiji Orenza injection, can you talk about your feelings? Professor Lin Tongyu is honored that Sichuan Cancer Hospital has become the first batch of prescription hospitals for WuXi Juno’s CAR-T product Ruiji Oranxel injection.
Thanks to my team and WuXi Juno for allowing our patients CAR-T treatment was carried out in the shortest time
.
I am a double-employed doctor at Sun Yat-sen University Cancer Hospital and Sichuan Cancer Hospital.
Many years ago, I have done many CAR-T clinical trials in Sun Yat-sen University Cancer Hospital
.
CAR-T is an immunotherapy, which is indeed effective for some patients.
Currently approved in China is relapsed or refractory large B-cell lymphoma (R/R LBCL), which is used in relapsed or refractory aggressive B-cell non- The complete response rate (CR) in Hodgkin’s lymphoma (B-NHL) patients is 40%-54%
.
Yimaitong: What are your prospects for cellular immunotherapy represented by CAR-T therapy? What are the prospects for individualized treatment and precision treatment in the field of hematological tumors in the future? Professor Lin Tongyu Actually, the concept of immunotherapy appeared as early as 100 years ago.
The interferon and interleukins used to treat tumors in the 1990s were all immunotherapy
.
Nowadays, high-dose interferons and interleukins still occupy a place in the treatment of tumors such as kidney cancer and malignant melanoma.
However, due to the high dose of the drug, the toxic and side effects are more obvious
.
At present, the generally accepted concept of immunotherapy should be popularized when the US FDA approved the first immunosuppressant ipilimumab in 2011
.
Because of its unique mechanism of action, immunotherapy has brought great changes to tumor treatment, overturned the thinking of tumor treatment in the past, and promoted the progress of tumor treatment
.
Since the US FDA announced that CAR-T was approved for marketing in 2017, CAR-T has been used in relapsed or refractory acute lymphoblastic leukemia (ALL), R/R LBCL, relapsed or refractory mantle cell lymphoma (MCL), and Treatment of relapsed or refractory multiple myeloma
.
This means that CAR-T also has a place in immunotherapy
.
However, the exploration of cell therapy is still very long, and clinical trials with different targets and different indications have yet to be carried out
.
In short, not all patients are suitable for CAR-T cell therapy
.
It is hoped that with the continuous progress of immunotherapy clinical research, CAR-T therapy can be applied to more cancer types
.
The treatment of hematological tumors has gone through the course of individualized and precise treatment from rough chemotherapy to immunotherapy and targeted therapy
.
After entering the era of targeted immunotherapy, more and more cancer patients have obtained longer survival times through targeted drugs and immunotherapy drugs
.
From CD20 monoclonal antibodies, to small-molecule tyrosine kinase inhibitors (TKI), and antibody-drug conjugates (ADC) such as anti-CD30 vebutuximab, all are leading the development of targeted immunotherapy
.
Targeted therapy and immunotherapy, as today's anti-cancer "sharp", are often presented in a way better than chemotherapy, but the role of chemotherapy cannot be ignored
.
It is foreseeable that the triple therapy of immunotherapy, targeted therapy, and chemotherapy will be the direction of future development
.
Taking targeted therapy as an example, the treatment targets of each patient are different, and target loss is prone to occur during the treatment process
.
At this time, if combined with radiotherapy, chemotherapy and other targets, it can increase the possibility of overcoming resistance
.
I hope everyone can continuously improve the quality of life of patients and prolong their survival period through the combined treatment of immuno-targeted chemotherapy
.
Yimaitong: What are the suggestions for the screening of the population with advantages of CAR-T treatment, the safety management during the treatment process, and the whole process management of CAR-T treatment? For the application of CAR-T, Professor Lin Tongyu has formulated a set of standard operating procedures (SOP).
Only patients who fail the second-line or third-line R/R LBCL can consider using CAR-T therapy, and they must have appropriate indications and sufficient The patient's informed consent
.
During the whole process management, especially the safety management, we should be highly vigilant about cytokine release syndrome (CRS)
.
During the treatment process, all participating doctors, nurses, and all staff should closely observe the patient
.
At the same time, patients should also inform their physical condition in time
.
Only with close cooperation between doctors and patients can the disease be finally overcome
.
Yimaitong: Regarding the specific practice of CAR-T therapy in cancer hospitals, what guidance and suggestions do you have? For the whole process management of CAR-T treatment, what kind of cooperation and cooperation are needed between the various departments of the hospital? Professor Lin Tongyu’s CAR-T treatment should be carried out in the department of hematology, oncology, and cancer hospitals in general hospitals.
Therefore, once a patient is diagnosed with malignant tumors, it is best to go to the department of hematology, oncology or cancer hospitals
.
Moreover, oncologists must be specialized, and hospitals must have strict specialized training and admission systems.
Only doctors who have undergone specialized training can be highly responsible for patients
.
I hope everyone can work together to do a good job in the diagnosis and treatment of patients
.
The whole-process management of CAR-T treatment does require the cooperation of various departments of the hospital, from the diagnosis of the pathology department and imaging department, to the screening of patient indications in the clinical department, to the detection of corresponding indicators in the laboratory, as well as the plasma exchange of the blood bank, and the pharmacy.
The emergency drug procurement, as well as the Department of Neurology and Infectious Diseases, are all critical
.
The whole process management of CAR-T treatment should be a manifestation of the overall strength of the entire hospital
.
In short, cancer treatment not only requires individualized, multidisciplinary comprehensive treatment, but also needs to pool the strength of the team.
I hope that everyone can unite and cooperate to benefit more cancer patients
.
Professor Lin Tongyu, University of Electronic Science and Technology of China Cancer Hospital • Sichuan Cancer Hospital Dean, professor, chief physician, doctoral supervisor, chief expert Professor, chief physician, doctoral supervisor of Sun Yat-sen University Cancer Prevention and Treatment Center, chief expert Chinese Medical Association Oncology Branch Chairman Zhong Zhong Head of the Lymphoma Group of the Oncology Branch of the Medical Association CSCO Rare Tumor Expert Committee Chairman CSCO Melanoma Expert Committee Vice Chairman CSCO China Lymphoma Alliance Vice Chairman China Anti-tumor Drug Safety Management Expert Committee Vice Chairman China Southern Cancer Clinical Research Association (CSWOG) Chairman, National Natural Science Foundation Review Expert, National Committee of Experts on Rational Use of Medicines and National Committee of Experts on Medical Malpractice Original ", we make progress together
