Imagine if cancers could be treated with an infusion of a therapy from the comfort of a doctor’s office?
This infusion would not deliver chemotherapy or radiation, but rather genetic instructions to reprogram a patient’s own immune cells into powerful cancer killing cells.
The instructions would be wrapped in a tiny, fat-based bubble to travel safely through the body and be delivered to the right cells.
This idea—where the body manufactures its own treatment for cancer—is at the core of in vivo CAR, a next-generation approach to treating cancer that is rapidly becoming the next frontier in cancer therapy, explained Dr. Salim Dhanji, CEO of ME Therapeutics.
In vivo CAR builds on the strong foundation set by standard CAR treatments, but overcomes issues related to the toxic, expensive and cumbersome process.
Since the first standard CAR treatment was approved by the FDA in 2017, it has revolutionized cancer treatment for blood cancers like leukemia, lymphoma and multiple myeloma. Success rates can be upward of 80%.
CAR treatments involve equipping a patient’s immune cells (typically T cells) with a receptor known as CAR—or chimeric antigen receptor—so they can recognize and kill cells that have become cancerous.
The current standard of CAR involves collecting these immune cells, sending them to a lab to be genetically modified, then reinfusing them back into the patients, alongside chemotherapy.
Because the genetic engineering needs to happen in a lab, the labour-intensive process carries a high price tag and is not accessible to the broad population.
In Canada, standard CAR also often involves shipping a patient’s cells across the border to the U.S., then back again, adding further complexity, explained Dr. Dhanji.
In vivo CAR holds the promise of delivering potentially the same therapeutic benefits of standard CAR treatments to cancer patients with a much simpler process—and consequently, more affordable and accessible.
These approaches can be applied to both T cells (CAR-T) and myeloid cells (CAR-M)
In vivo CAR-T and CAR-M work by delivering genetic instructions into a patient’s body to reprogram their immune cells directly and turn them into cancer killing cells.
The next-generation approach eliminates the need to collect a patient’s cells, send them to a lab, then reinfuse them, alongside chemotherapy.
End result is faster access to treatment with less risk of side effects
This forefront of immuno-oncology is still in its early days.
In vivo CAR has yet to be proven out in clinical trials, with the most advanced therapies currently only in Phase 1 trials, but all signs point to the promise this approach will work, said Dr. Dhanji.
In Canada, ME Therapeutics recently licensed a nanobody-based binder developed by the Canadian government (National Research Council Canada) that targets a protein in certain blood cancers (CD22) — and will now advance in vivo CAR therapy candidates through preclinical studies.
Delivery will be a crucial part of the success of in vivo CAR approaches, explained Dr. Dhanji. In ME Therapeutics’ case, the company is partnering with NanoVation Therapeutics, another Canadian company, to use proprietary delivery technology—called long-circulating lipid nanoparticles—to get the genetic instructions to the right place in the body.
While still in early development, momentum for in vivo CAR is building in the U.S., Canada and globally.
Researchers, biotech companies and delivery-technology innovators are all working to make CAR cell therapy faster, safer and more accessible for cancer patients who today have limited treatment options.
In vivo CAR holds the promise of being one of the most transformative advances in the fight against cancer since the advent of immunotherapy — opening up cancer treatments for the broader population in a way not possible today.
