Cancer treatment has come a long way from the early days of chemotherapy. While the treatment undoubtedly revolutionized cancer care, according to Zachary Roberts, MD, chief medical officer at Allogene Therapeutics, “chemotherapy is a double-edged sword.” While it can be extremely effective at fighting cancer cells, chemo drugs on their own don’t discriminate, and they often end up damaging healthy cells along the way.
That’s why the modern approach to cancer care involves more than just chemo. In fact, says Dr. Roberts, physicians focus on three pillars: “chemotherapy, targeted therapy, and immunotherapy.” An advanced form of immunotherapy, chimeric antigen receptor T-cell therapy (CAR T), actually uses a patient’s own cells to fight the disease. In standard (autologous) CAR T, a patient’s T cells are harvested, genetically reprogrammed to recognize a specific tumor marker, multiplied into millions, and then reinfused back into the patient. The result, explains Dr. Roberts, is “an entire army” all focused on the same target, that you can deploy to eradicate the tumor. The infusion itself lasts minutes, but Dr. Roberts says the results can be extraordinary: “Patients come in one month after their infusion, and they’re in complete remission…with some remissions lasting five years or more.”
So if this is potentially a game-changing way to fight cancer, why aren’t more people getting it? It’s because for most, this type of bespoke therapy is out of reach. “Even today, only about 20 percent of eligible patients get CAR T,” says Dr. Roberts, citing lengthy manufacturing times, and the fact that it’s generally only available at major academic centers. “There are multiple barriers that prevent patients who could potentially have their lives saved from getting this therapy.”
Fortunately, a promising next-generation CAR T being evaluated in a new clinical trial may help address these access challenges: allogeneic, or “off-the-shelf,” CAR T. Instead of making a personalized product for each patient, allogeneic CAR T uses cells taken from healthy donors. These donor cells are engineered to target cancer while avoiding immune rejection, and are produced in standardized, ready-to-use batches that can be shipped at the moment they are needed. “From a single donation, we can make up to a thousand doses,” Dr. Roberts says. “We can ship our CAR T to local practices, so patients can receive it from their primary oncologist.”
The hope is that the allogeneic CAR T being studied in the ALPHA3 trial — if proven safe and effective — will increase accessibility by making treatment both faster and accessible. Using new investigational minimal residual disease (MRD) blood tests, which can detect tiny traces of cancer DNA even after remission, access to “off-the-shelf” CAR T means patients can begin treatment while they’re still strong — potentially stopping relapse before it occurs.
While cancer remains a formidable, ever-changing opponent, the direction of progress is clear: toward therapies that are more precise, and ultimately more equitable. And with studies like ALPHA3, that future may be closer than we think.
