The innovative cell therapy with CAR T lymphocytes is achieving, in blood cancers, “potentially cured patients” in cases that no longer had other treatment options. Interview with the president-elect of the Spanish Society of Hematology and Hemotherapy (SEHH), María Victoria Mateos, on World Cancer Day.
The elected president of the Spanish Society of Hematology and Hemotherapy (SEHH), María Victoria Mateos, at the University Hospital of Salamanca. EFE/JM Garcia
CAR T immunotherapy consists of genetically modifying the patient’s T lymphocytes so that they carry a receptor on their surface that directs them towards malignant cells and, once it binds to them, activates and manages to destroy them.
This cell therapy is one of the latest-generation drugs that is changing the course of the disease by increasing survival in the most common blood cancers: lymphomas, leukemias and myeloma.
It is approved for acute lymphoblastic leukemia (in children and adults) and for some types of lymphoma (such as diffuse large cell non-Hodgkin or mantle lymphoma) and now a drug has just been authorized for relapsed multiple myeloma that has not yet arrived to Spain.
“We have a proportion of patients, 30-40%, that we can consider potentially cured or, at least, long survivors for 5 or 6 years when before they did not have many more treatment options, these are very positive data”, explains the specialist. of the Department of Hematology of the University Clinical Hospital of Salamanca
CAR T cell therapy consists of a single infusion, unlike conventional chemotherapy treatment that requires longer periods of time, and this affects the quality of life of the patient.
This immunotherapy is already positioned “as a standard of treatment to achieve curative strategies” for an increasing number of patients and towards earlier lines for hematological cancers, since in solid tumors they are still in the research phase, he specifies.
According to the expert, after a first implementation of this strategy in a dozen hospitals of the National Health System, “the time for expansion has come” as it has a manageable safety profile, is feasible and has more and more candidate patients.
The challenge of asymptomatic myeloma
María Victoria Mateos is an international benchmark in multiple myeloma, a cancer that affects the plasma cells of the bone marrow that causes bone pain, anemia or kidney failure and is diagnosed, on average, at 65 years of age.
“I think we’re scared to say we cure myeloma patients, but we have them. It has gone from being a disease that did not have more than 2 or 3 years of survival to patients with free disease to progress for more than 9 and 10 years, “says the also head of the Myeloma Unit at the Salamanca Hospital.
As a researcher and coordinator of the Spanish Myeloma Group (GEM), she works on the challenge of detecting this cancer early, in a premalignant stage, and controlling it before it becomes active, which in high-risk cases does so after a few two years.
“And we embarked on that in 2007 with a pioneering clinical trial in the world, we proved that early treatment benefited these patients. It was the starting point for a large number of clinical trials worldwide, ”he highlights.
For this reason, the person also responsible for the Myeloma Unit at the Salamanca Hospital insists on the need to access new therapies where the outlook is “hopeful”.
Spain lags behind in access to innovative drugs
These next-generation drugs are the ones that are increasing survival in hematological cancers, third in the general classification of cancer after lung and breast tumors.
In Spain, some 10,000 cases of lymphoma, 6,000 of leukemia and 3,000 of multiple myeloma are diagnosed annually, with a gradual increase in survival thanks also to earlier and more precise diagnoses due to knowledge of molecular markers, targets of therapies.
A therapeutic revolution in which Spain is lagging “far behind” because the health authorities do not see the “magnitude of the benefit” of some medicines that, although they are tested in clinical trials in Spanish hospitals, are not authorized or financed so that they arrive to all patients.
“It is very frustrating – he regrets – to work with drugs, with new combinations, that we offer to some patients in clinical trials, that later the regulatory agencies at European level approve, but that in the end you cannot give to the patient”.
If there is no universal access to oncology innovation, “I would dare to say that Spain may no longer be the ideal place to carry out clinical trials”, tests that have an impact on overall survival, warns the coordinator of the Clinical Trials Unit of the Department of Hematology of the Salamanca Hospital.
“Even more so -he points out- with the entry into force of the new regulations for the development of clinical trials where the aim is to speed up and make clinical trials reach the entire European community at the same time. Before it did not happen and Spain was a priority country ».
“The bottleneck is in the Spanish Medicines Agency”, points out the hematologist who understands that, specifically, the coronavirus pandemic will delay the evaluation processes of innovative cancer drugs.
“But now -he assures- it is already unblocking, there are evaluations, the problem is if the result of these evaluations is ‘no financing’ for these drugs”.
And the reason is, according to the hematologist, that “the Ministry of Health does not see the magnitude of the benefit” that, in the specific case of drugs for blood cancers, are changing the course of the disease.
Mateos calls on the Ministry of Health to meet with researchers and doctors and reach a “consensus” that avoids the lack of equity in Spain compared to other European countries.
“I think we have to get our act together and try to force innovation to reach patients,” he insists.
Next October, María Victoria Mateos will assume the presidency of the SEHH with the experience of being a member of the European and American societies of Hematology and member of the Executive Committee of the International Myeloma Society, with more than 150 publications in scientific journals.
Mateos, who will replace Dr. Ramón García Sanz, will be the second woman at the head of this medical society after the hematologist Carmen Burgaleta, who held the presidency from 2011 to 2013.
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