The Royal Marsden

Infused with potential

Using the body’s immune cells to target cancer, cellular therapies are showing great promise – and The Royal Marsden is at the forefront.
Dee Maloney, Clinical Nurse Specialist

Dee Maloney, Clinical Nurse Specialist

Cellular therapies are emerging forms of immunotherapy that harness the power of T cells – a key infection-fighting immune cell – to target both blood cancers and solid tumours.

These complex therapies use a technique known as adoptive cell transfer, in which the patient’s own T cells are harvested to be grown or modified in a laboratory to boost their ability to attack cancer, before being given back to the patient.

The Royal Marsden’s cellular therapy programme has grown significantly since we treated our first patient in 2019. To support this expansion, we have set up the Cancer Biotherapeutics Unit and upgraded our stem cell and cellular therapy laboratory.

Today, we are one of the NHS’s approved centres for chimeric antigen receptor T-cell (CAR-T) therapy and have treated more than 20 patients with NHS-approved CAR-T products since December 2019. We are also set to use other pioneering cellular therapies, including tumour-infiltrating lymphocyte (TIL) therapy and T-cell receptor (TCR) therapy in clinical trials.

CAR-T therapy

In CAR-T therapy, T cells are isolated from the patient’s blood using an apheresis machine, in the similar way that stem cells are harvested before a transplant. They are modified to produce proteins called chimeric antigen receptors that allow them to recognise and lock onto cancer cells, and these CAR-T cells are then reinfused into the patient’s bloodstream.

This promising treatment is approved on the NHS for patients with relapsed diffuse large B-cell lymphoma and relapsed mantle-cell lymphoma (a rare type of non-Hodgkin lymphoma), as well as patients aged up to 26 with relapsed B-cell acute lymphoblastic leukaemia.

“The three CAR-T products currently available on the NHS target the CD19 antigen biomarker,” says Dr Emma Nicholson (pictured below), a Consultant Haematologist who leads on the development of cellular therapies for blood cancers in the Cancer Biotherapeutics Unit. “A clinical trial is due to open soon that will target a marker called BCMA and will recruit patients with plasma cell myeloma who aren’t able to have stem cell transplants.”

Dr Emma Nicholson, Consultant Haematologist at The Royal Marsden

Patient support

Patients who undergo CAR-T therapy are supported by a multidisciplinary team of doctors, nurses, psychologists, allied health professionals, pharmacists, and Critical Care Unit (CCU) and palliative care specialists.

“Our patients have relapsed disease, so waiting up to a month for their personalised CAR-T product to be manufactured is a stressful time for them and their families,” says Dee Moloney, a Clinical Nurse Specialist who focuses on cellular therapy treatments. “We offer bridging therapy – such as further chemotherapy, radiotherapy or steroids – as a means of keeping their disease under control until they can receive CAR-T therapy.

“Patients may also require CCU support, so we have an excellent team who monitor, treat and help them recover after the infusion.”

Solid tumours

Beyond CAR-T therapy, additional approaches are being explored against solid cancers, including TIL and TCR therapy. In particular, there have been promising results in clinical trials for patients with advanced melanoma for whom standard immunotherapy has been unsuccessful.

With this treatment, part of the tumour is surgically removed in order to harvest T cells that are naturally capable of infiltrating the cancer. These are then activated and grown in large numbers before being reinfused into the patient.

Dr Andrew Furness (pictured below), a Consultant Medical Oncologist who is leading on cellular therapies in solid tumours for the Cancer Biotherapeutics Unit, says: “TIL therapy appears to offer the potential for durable control for a proportion of patients with advanced melanoma whose disease appears resistant to standard approaches.

Dr Andrew Furness, Consultant Medical Oncologist

“We are now looking to extend this therapy to patients with other tumour types, including advanced lung and head and neck cancers, at an earlier stage in their treatment.”

What the future holds

This year, led by Dr Furness, The Royal Marsden will open its first trial of TCR therapy for patients with a rare type of sarcoma. Like CAR-T therapy, TCR therapy involves modifying T cells with a receptor so they recognise specific targets in a patient’s tumour.

Meanwhile, the Cancer Biotherapeutics Unit will continue to explore how effective cellular therapies are in treating blood cancers and solid tumours. It will focus on whether we should be using cellular therapies as a first-line treatment, understanding why some patients experience adverse side effects, and how to select patients who will have the best response.

A patient's perspective

Kevin McNulty, 71

“I had CAR-T therapy to treat my diffuse large B-cell lymphoma last year. I was diagnosed with stage 4 disease in 2019 and had been through two lots of chemotherapy when I was told it was not working. I was at my lowest ebb. Without treatment, it was predicted I’d last a couple of months.

“I’d never heard of CAR-T therapy when the doctors first mentioned it. It sounded like science fiction compared to my previous treatments, but I had run out of options. After speaking to Dr Nicholson about the process, it was an easy decision to go for it.

“I went to The Royal Marsden in Sutton to have my T cells taken from my blood using an apheresis machine in early May. I had some holding treatment to keep me going for the month while I waited for my cells to be modified and infused back into me.

“I was in hospital in Chelsea for a month following the infusion – and for a few of those days, I was in the CCU. But on day 28, a scan showed I was clear of disease. I could not be more grateful.”