The patient, Kyle resident Brianna Bonnet, says the new treatment for her lymphoma turned her blood cells into “ninjas.”
Her doctor is a bit more scientific in his explanation.
Bonnet, 34 and a kindergarten teacher in Austin, began receiving CAR-T, a new form of immunotherapy, in 2018, and she was the first Texas Oncology patient from the Austin area to do so.
Two years later, she is back in the classroom and her physician, Jason Melear, M.D., medical oncologist and hematologist at Texas Oncology, says she has responded wonderfully. “The last time I saw her she was doing great, and I’m going to see her again in the next few weeks,” he said.
The treatment was approved by the FDA in 2017 to treat very specific types of lymphoma and leukemia and, Melear said, is still so new that some insurance companies are “strugging” with how to approve it.
Basically, CAR-T involves taking T-cells, part of the body’s immune system “involved in attacking foreign cells” out of the patient, then sending them off to a specialized lab where they are “essentially reprogrammed to attack the cancer cell.
Cancer cells have proteins on their surface, Melear explained, and the reprogrammed cells “hone in only on the cancer and kill it.”
Though tests are ongoing, the treatment is currently approved only for “a couple of indications.” Melear said testing focuses on being able to widen the “targets” for the reprogrammed cells. “Theoretically it could work for any type of tumor, you just have to find the right target,” he said.
A strength of the treatment is that there are fewer side effects and no possibility of rejection because the reprogrammed cells are the patient’s own.
“It’s like a living drug, the drug itself is alive. Your T-cells, they float around the body and find these cells and fight them and kill them like they would viruses … the nice thing is, old treatments like chemotherapy attack fast-growing cells of all types. This doesn’t. People who might be resistant to chemotherapy won’t be resistant to this.”
Bonnet is his only patient to have received the treatment, he said. “She had a very aggressive type of lymphoma” and “did very well” with chemotherapy, though it didn’t kill all the cancer cells. He then initiated a second type of chemotherapy but “didn’t get a good response.”
Then, Bonnet was started on immunotherapy, which uses the body’s own immune system.
“She got a response but it hadn’t shrunk away completely. She was given some time essentially.”
By the time she started undergoing CAR-T, “She didn’t have any other good options.”
“We tried every treatment possible,” Bonnet said. “We basically did everything there was and nothing worked. Thankfully CAR-T was approved right when I needed it.”
She had to go to Dallas for the five- or six-hour procedure by which the cells were taken out of her body and, after a couple of weeks in the hospital, had to remain nearby for daily visits with doctors during which she was tested physically and mentally. “They ask you questions, who is the president, what year is it. I had to write a sentence over and over.”
She was released from the hospital right after Thanksgiving and in June of 2019, interviewed for her current job. Her return to the classroom in the fall of last year was “bittersweet,” because although teaching is her passion, some parents who had read her blogs “actually called administration to say they didn’t want their child in my classroom” because of the cancer.
“Before they even saw me, even knew me — if I had been keeling over dying I would understand. But they’d never seen me or met me. That’s just crazy to me.”
There were other consequences as well. Though she’d always wanted to be a mother, the treatment had dire consequences for her fertility. “I’m not able to have children now. Cancer literally takes your whole life away. I lost my hair three times. Physically, emotionally, it’s really tough. It’s more emotionally hard than the actual physical going through it.”
As for the future of CAR-T, Melear said only time will tell. “We will run into snags, if history teaches us anything,” he said. “At last we have a new therapy for cancers that are usually fatal.” If patients who had “very short life expectancies” can be put into long-term remission, “That’a a huge step forward.”