Patient Stories > Family Sees a Future Without Cancer Thanks to CAR-T Cell Therapy
Family Sees a Future Without Cancer Thanks to CAR-T Cell Therapy
By Matt Derechin
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At first, Tanis Milicevic’s local doctor told her to wait and see. Pregnant with her second child, Tanis had been sensitive about changes in her body when she felt a worrisome bump on the back of her head.
The doctor’s advice gave her temporary peace — the bump was small and she could just monitor it. Then, after her baby’s first birthday, Tanis felt a lump in her underarm.
“That’s when I knew that
something was not right,” she says. Although she otherwise felt
fine, her instincts about her health were correct. A biopsy showed
she had non-Hodgkin’s
lymphoma.
Tanis and her husband, Marko, learned that while her disease was slow-growing at this stage, it would also be hard to cure. “It was a difficult pill to swallow, but we remained optimistic. You live life and push forward,” Marko says. They had to for their sons, 1-year-old Jonathon and 8-year-old Max.
Tanis, then 44, underwent radiation
and then chemotherapy
for two years. The treatments kept the cancer
in remission for five years. It freed her to focus on her family and
her business, a women’s contemporary fashion boutique.
When the cancer returned, Tanis came
to Mayo
Clinic.
Under the care of hematologist Han
W. Tun, M.D., at Mayo’s
campus in Florida, Tanis tried two new chemotherapy
treatments to manage the recurrence, as well as a second relapse 18
months later. Her cancer was transforming and becoming more
aggressive.
At the end of 2017, Tanis reviewed
her options with Dr. Tun. It was just a matter of time before the
next recurrence. The therapy for this type of cancer is usually a
stem
cell transplant, but Tanis had no suitable matching
donor.
There was still hope. A new treatment was just approved by the Food and Drug Administration for Tanis’ type of lymphoma. Known as CAR-T cell therapy, it had been shown to improve remission and survival rates after other treatments had failed.
Mayo Clinic had taken part in
pivotal clinical trials that led to FDA approval and was one of the
first medical centers in the nation offering the therapy.
“I thought, I don’t think
anything could come at a more perfect time for me,” she says. And
in 2018, Tanis became the first patient at Mayo Clinic’s Florida
campus to receive CAR-T cell therapy.
Revolutionary Treatment
CAR-T cell therapy, or chimeric
antigen receptor-T cell therapy, is an individualized treatment that
uses a patient’s own cells to fight cancer. T cells are a type of
white blood cell in the immune system that protect people from
infection. In CAR-T cell therapy, T cells are collected from a
patient’s blood, genetically altered in a lab, multiplied and
returned to the patient’s bloodstream. The alteration gives T cells
the chimeric antigen receptor, which helps T cells recognize, latch
onto and kill the intended cancer cells.
“I think that in the past 10 years
or so, probably this is the most innovative and revolutionary
treatment that our field has seen,” says hematologist and
oncologist Mohamed
A. Kharfan Dabaja, M.D., the director of the Blood and
Marrow Transplantation Program and the Human Cellular Therapy
Laboratory at Mayo Clinic’s Florida campus.
What has been exciting to cancer
physicians and researchers is how CAR-T cell therapy is helping some
patients achieve complete remission, even after other forms of
treatments have failed. In complete remission, there are no symptoms
or signs of cancer and it is not detectable, although it could return
later.
“It has improved that complete
remission rate by sevenfold,” Dr. Kharfan Dabaja says.
When patients achieve complete
remission, they have a better chance of surviving, he says. Survival
rates two years after treatment are shown to have improved — from
as low as 15% to over 50% on CAR-T cell therapy, according to Dr.
Kharfan Dabaja.
CAR-T cell therapy is fast-acting, showing evidence of response within one to three months. It stands out among similar cancer therapies in terms of how it overcomes obstacles — such as vast numbers of cancer cells and suppression of the immune system by cancer — quickly and on its own.
Potential Options
The FDA has approved two CAR-T cell
therapies. Presently, both can treat adults with certain types of
non-Hodgkin’s lymphoma, but only one treats children and young
adults, up to age 25, with B-cell acute
lymphoblastic leukemia. The therapies are used after
at least two previous treatment options have failed. They are not yet
approved for use in earlier stages of the cancers.
Mayo Clinic is one of the few
medical centers certified to offer the FDA-approved therapies. Mayo
is also one of the few centers to have experience treating patients
with the FDA-approved therapies and in clinical trials. The
treatments are available at each of Mayo’s main campuses in
Arizona,
Florida
and Minnesota.
CAR-T cell therapy requires the
multidisciplinary specialty care that Mayo Clinic provides,
especially once the CAR-T cells are infused back into a patient’s
body, where they release chemicals as they kill cancer cells. The
resulting symptoms can be severe.
“These are living drugs,” says
Yi
Lin, M.D., Ph.D. She leads the Cellular Therapeutics
Cross-Disciplinary Group at Mayo
Clinic Cancer Center. “Patients oftentimes need
hospital, even ICU-level, support. They need to be at a very
experienced center as they go through the treatment.”
Mayo Clinic continues to drive
forward new research in CAR-T cell therapy, expanding clinical trials
with a focus on using the treatment at earlier stages of cancer and
in more types of cancer; countering the side effects and safely
delivering treatment; and even using CAR-T cell therapy for
conditions beyond cancer. All of Mayo’s main campuses will have
trials open for various types of blood cancer this year.
Complete Remission
Tanis met with Dr. Kharfan Dabaja in
2018, and in late spring, she began the CAR-T cell treatment.
Unfortunately, Tanis experienced severe side effects and was
hospitalized longer than she expected, including time in the ICU.
While it was difficult for Tanis,
Marko and their family, the outcome was the result they had hoped
for: Six weeks after treatment, Tanis was in complete remission.
“This is a patient that had not
seen a complete response for many, many years,” Dr. Kharfan Dabaja
says. “Now she is experiencing a complete response, and with time,
her condition has improved significantly, where she’s almost back
to her normal life,” he says.
Tanis reached an important landmark
when she was still in complete remission 90 days after her treatment.
More than half the patients who reach the 90-day mark will be alive
two years later, Dr. Kharfan Dabaja says.
Now, for the first time in a decade,
Tanis and her family are thinking of a future without cancer.
“Tanis has gone through all the
different treatments. This one definitely feels the most amazing,”
Marko says. “It has allowed me to have my wife, and our kids to
have their mom.”
“It’s given me the chance to live, and I’m forever grateful,” Tanis says, “My advice for anybody else who has lymphoma is to know that there is hope.”
