The MSK Experience – Learning from Pioneers
When I left Brisbane, where I was consulting at South Brisbane as a Haematology Fellow, to join Memorial Sloan Kettering Cancer Center (MSK) in the United States, my aim was to fully immerse myself in the field of cellular therapy.
I had the privilege of working alongside world-leading experts who are pioneers in CAR T-cell therapy, gaining invaluable hands-on experience with some of the most advanced treatments available.
As a member of MSK’s Cellular Therapy Service, I saw the profound effects CAR T-cell therapy had on patients with blood cancers whose cancers had resisted conventional treatments. In some instances, this therapy even proved curative—an outcome that redefines the goals we set for our patients.
At MSK, I also learnt that CAR T-cell therapy is only the beginning.
Scientists are constantly refining and developing new cellular therapies to target cancers more effectively. Beyond CAR T-cells, treatments like tumour-infiltrating lymphocytes (TIL) and T-cell receptor (TCR) therapies are emerging, designed to tackle the unique challenges presented by different cancer types. I was fortunate to treat patients with these therapies, each tailored to meet the demands of specific cancers, including solid tumours like melanoma and lung cancer.
Cellular therapy – creating opportunities in Australia
Returning to Australia to take up Icon’s new role of Deputy Director of Cellular Therapy, thanks to a generous donation to Icon Cancer Foundation, I’m inspired to make these innovative treatments accessible to more patients.
While there are unique challenges in introducing these therapies across the country—particularly logistical complexities, potential side effects, and costs—my Icon colleagues and I are committed to broadening access.
Icon is the largest provider of autologous transplants in Southeast Queensland and are well established experts in bone marrow transplants. The capabilities required for CAR T-cell therapy are very similar to that required for bone marrow transplants. This means Icon’s infrastructure and capabilities provide a strong foundation for bringing cellular therapies to Australian patients.
The cost and logistics of CAR T-cell manufacturing remain barriers, but promising developments are already underway to tackle these.
Innovations such as point-of-care manufacturing and allogeneic T-cells, which can use donor cells, have the potential to reduce both the costs and time of production, making these treatments more affordable and accessible.
While at MSK, I was involved in a clinical trial that explored ways to minimise the side effects of CAR T-cell therapy, which highlighted the importance of proactive patient management.
Sharing this experience with healthcare providers in Australia will be essential as we establish a local base of expertise in these therapies. In line with clinical knowledge sharing, we also need to start conversations with government and lobby for further investment in cellular therapies.
Evolutions in Cellular Therapy
CAR T-cell therapy for patients with blood cancers is currently recommended as a treatment option if chemotherapy has not been sufficiently effective, and the disease has returned, or if patients have developed resistance to their initial treatment. It has also shown potential to replace existing treatments such as bone marrow transplantation.
CAR T-cell therapy hasn’t worked as well in solid tumours as they are often difficult for the T-cells to penetrate. Like a moat around a castle, tumours are also surrounded by cells and molecules that hinder the T-cells until they run out of steam. Although there are currently no approved CAR T-cells to treat patients with solid tumours, scientists and clinicians are studying investigational CAR T-cells in many solid tumours, including mesothelioma, prostate cancer, breast cancer, gastric cancer, renal cell carcinoma and brain cancer.
Aside from CAR T-cells, scientists are also exploring innovative, next-level cellular therapy approaches in solid tumours, such as TIL and TCR therapy.
Interestingly, CAR T-cells are also being explored beyond oncology. Engineered T-cells have shown great promise in autoimmune diseases, including systemic lupus erythematosus (SLE).
