Unlike chemotherapy or radiation, which attack cancer directly, CAR-T engineers the patients' immune cells so that they can do it on their own. T cells are removed from the blood and given new genes that produce receptors that allow T cells to recognize and bind to leukemic cells with a specific CD19 protein.
The genetically modified T cells then multiply in the laboratory and flow back into the patient, where they ideally multiply further and begin to target and kill cancer cells with CD1
There are two CAR-T therapies on the market today: Kymirah and Yescarta. However, the availability of medicines does not mean that they are ideal for all patients or without side effects. Patients using the new treatment are susceptible to headaches, seizures and other neurological symptoms, some severe. Treatment is also extremely expensive and skilled caregivers are often close to death.
Jurkevich examines these problems, explains why they are used only in patients with some cancers – some leukemias and lymphomas – and investigates questions about why they have not yet been shown to work against solid tumors.
Jurkevich is not only a doctor: She is also a journalist and weaves a story that is as intriguing as it is informative.
From the history of therapy, the first clinical trial of billing patients has been performed, its deeply human tale of hope, research and a potentially dangerous path to recovery for patients choosing CAR-T, which means T-cell for the chimeric antigen receptor.
"To hope for a miracle as we prepare to die are mutually compatible ideas," Jurkevich writes. "For an opponent as heavy as cancer, we will take every tool we can get."