Professor Liu Yao issued the first batch of prescriptions for CAR-T in Chongqing, writing a new chapter in the treatment of hematological tumor patients

Chimeric antigen receptor T (CAR-T) cell therapy, as a new type of precision targeted therapy in recent years, has achieved great success in the treatment of hematological tumors
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At present, global CAR-T clinical trials are in full swing, and new CAR-T drugs are also on the market in China
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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
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On this occasion, Yimaitong sincerely invites Professor Liu Yao from the Cancer Hospital of Chongqing University to accept an interview to share the clinical experience of CAR-T treatment
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Yimaitong: The prescription for the first patient treated with Ruiji Orenza injection in the Affiliated Tumor Hospital of Chongqing University has been issued.
What factors did you take into consideration when prescribing? How does it feel to work with WuXi Juno for the first time? Professor Liu Yao On September 23, 2021, after a comprehensive assessment of the patient’s condition, we prescribed the first patient treated with Ruiji Orenza injection
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Before prescribing, you must first understand the indications of the product.
The current approved indications for CAR-T are patients who have received at least second-line treatment and the treatment has failed, or the autologous hematopoietic stem cell transplantation has failed
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Therefore, before CAR-T treatment, it is necessary to evaluate the patient's previous treatment and whether it meets the indications
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In addition, it is necessary to fully communicate with patients and their families to clearly inform the price of the product and the possible risks, related adverse reactions and benefits of the drug
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This is the first collaboration between us and WuXi Giant Nuo
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The company is full of confidence in its products.
The robust production process and rigorous quality control ensure the consistency and stable quality of the final product, and there are experienced staff to do the whole process
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Throughout the treatment process, we are comrades-in-arms working side by side with the patients, family members, and WuXi Junuo.
We all hope to find the best treatment plan and prolong the life of the patient
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Yimaitong: Which patients are suitable for CAR-T treatment in the clinic? How to screen patients before treatment? How to maximize the benefits of patients during treatment? Professor Liu Yao is currently undergoing clinical research on the applicable population of CAR-T therapy
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However, clinicians really use drugs to treat patients only for the indications approved by the State Food and Drug Administration.
This is the bottom line and basic principle for screening patients
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At present, the indications approved for Ruiji Orenza injection in China are: adult patients with relapsed or refractory large B-cell lymphoma who have failed after second-line or above systemic treatment, including diffuse large B-cell lymphoma.
Diffuse large B-cell lymphoma transformed from follicular lymphoma, grade 3b follicular lymphoma, primary mediastinal large B-cell lymphoma, high-grade B-cell lymphoma with MYC and BCL-2 and/or BCL -6 rearrangement (double-hit/three-hit lymphoma)
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Under the premise of meeting the indications, the following factors should be considered in screening patients: First, try to control the patient’s condition and avoid CAR-T treatment during the advanced stage of the disease; second, the patient’s physical status must meet relevant standards and be able to Withstand the collection and cleansing before CAR-T cell infusion
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In addition, it is also necessary to consider whether the patient can maximize the benefit from CAR-T cell therapy
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Preliminary clinical studies have found that if patients have large lumps, or elevated lactate dehydrogenase levels before CAR-T cell therapy, and poor physical status, low levels of hemoglobin and platelets, they can benefit from CAR-T cell therapy.
It is less likely to benefit
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Preliminary clinical studies have suggested that the lower the tumor burden of the patient before treatment, the greater the possibility of benefiting from CAR-T cell therapy in the future
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In addition, how to deal with side effects after CAR-T cell infusion is also an important factor affecting the survival of patients.
Therefore, patients must be closely observed after CAR-T cell infusion.
If adverse reactions occur, they must be dealt with in time
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Moreover, follow-up after CAR-T cell infusion is also very important, and it is an important factor affecting the overall benefit of patients
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In short, CAR-T treatment is a systematic project.
Only by doing the pre-screening, collection, culture, cleansing before reinfusion, reinfusion, and follow-up after reinfusion, can the patients maximize the benefits
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Yimaitong: What is the difference between the full-course management of CAR-T treatment and traditional treatment? What are the main aspects? What kind of cooperation is needed between multiple departments of the hospital? Professor Liu Yao currently, CAR-T cells are used as a special medicine to treat patients with lymphoma, and the whole course of management should be followed during the treatment
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Due to the particularity of CAR-T cell drugs, compared with traditional treatments, CAR-T treatment is more rigorous throughout the entire treatment process, and intervention is required even during cell collection
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The whole process management of CAR-T treatment includes patient screening and evaluation, cell collection, preparation before reinfusion, reinfusion, follow-up after reinfusion, etc.
It involves not only hematology, lymphoma and other specialists, but also many other processes.
clinical departments (such as respiratory, renal medicine, cardiology, gastroenterology), apheresis room, ICU, laboratory, department of pathology, Radiology department and so on
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This is a holistic treatment model under multidisciplinary collaboration.
It is impossible for any independent department to perform CAR-T cell therapy completely and safely
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Because CAR-T cell therapy has its potential risks, including cytokine release syndrome, central nervous system toxicity, etc.
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Therefore, CAR-T treatment is a collaborative project of the whole hospital
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Yimaitong: With the successive launch of CAR-T products, China will officially enter the first year of commercialization of CAR-T products in 2021.
What are your expectations and prospects for the future of CAR-T cell immunotherapy in China? Professor Yao Liu CAR-T cell therapy as an innovative treatment model has broad development prospects, but the current scope of application is mainly concentrated in the field of relapsed and refractory hematological tumors
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Pre-clinical data showed that in patients with non-Hodgkin's lymphoma, the 4-year progression-free survival rate of CAR-T cell therapy was 44%
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Due to the short time to market for CAR-T products, data such as "5-year survival rate" for evaluating long-term efficacy have not yet been obtained.
It is still necessary to continue to pay attention to the survival benefits of patients using CAR-T cell therapy
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CAR-T cell therapy is effective in hematological tumors such as acute lymphoblastic leukemia and lymphoma, but it is still in the exploratory stage in solid tumors.
It is hoped that clinical researchers will expand the applicable population of CAR-T cell therapy by optimizing the structure and other methods.
The scope will benefit more cancer patients
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Professor Liu Yao Director, Chief Physician, Professor, Postdoctoral Cooperative Supervisor, Hematology Oncology Center, Affiliated Tumor Hospital of Chongqing University Member of the Hematology Special Committee of the Chinese Society of Clinical Oncology CSCO Anti-Lymphoma Alliance Leader of the Central and Western Immunodeficiency-related Lymphoma Diagnosis and Treatment Collaboration Group Chairman, Chongqing Integrative Medicine Association, Precision Medicine and Molecular Diagnosis Committee Chairman, Hematology Youth Committee Vice Chairman of the Association, National Natural Science Foundation of China, First Review Expert, "Chongqing Medicine", "International Journal of Laboratory Medicine" Editorial Board, "Chinese Tissue Engineering Research", "Chinese Journal of Clinicians", "JHO", "Leukemia Research" and other journal reviewers Poke "read the original text", we make progress together