Why a 78-year-old patient traveled to China for CAR-T therapy

At 78, a retired family medicine doctor from New Zealand faced a health crisis: high risk multiple myeloma. After years of conventional treatments had been exhausted, his path to a potential remission led him on a 9,000-kilometer journey to Shanghai, China. 

His case highlights the increasing role of Chinese medical institutions in providing advanced cancer care to international patients.

Targeting cancer cells with CAR-T therapy

The patient's medical history was complex. He had a multi-year history of multiple myeloma, a cancer of the plasma cells, which had relapsed despite multiple lines of therapy. A major complicating factor was chronic kidney disease, a common secondary effect of the malignancy.

Dr Hao Siguo, chief hematology consultant at Jiahui International Hospital, explained that with conventional chemotherapy options exhausted and non-curative, CAR-T therapy remained the only viable path to achieving a potential remission. 

Hao noted that China has become an attractive destination for such treatment due to its rapid regulatory approvals, high-volume clinical experience and significantly lower costs – often one-third to one-half of those in the West – without compromising safety or efficacy. 

A comprehensive evaluation confirmed that while this patient's chronic kidney disease was a major concern, it did not exclude him from receiving the recommended CAR-T therapy. 

CAR-T cell therapy is a form of immunotherapy that genetically engineers a patient's own immune cells to combat cancer. The process involves collecting the patient's T-cells – a type of white blood cell – which are then sent to a specialized laboratory. There, scientists modify them to express a Chimeric Antigen Receptor (CAR), which acts like precision GPS, programmed to recognize a specific marker on the patient's cancer cells. 

These reinforced CAR-T cells are multiplied into an army of millions before the patient receives the infusion, where they actively seek out and eliminate the targeted cancer cells.

China's position in global CAR-T development

While CAR-T therapy is currently available in a few countries globally, including the United States and China, it's not available in the patient's home country of New Zealand. 

China is now a significant center for the development and application of CAR-T cell therapy, ranking only second to the United States in both the number of clinical trials and the volume of treated patients.

Advancements in China include research into using CAR-T for solid tumors, moving beyond its initial success with blood cancers. Furthermore, Chinese scientists are actively developing off-the-shelf or allogeneic CAR-T therapies, which utilize cells from healthy donors, potentially reducing the cost and waiting time for treatment.

A September paper in "The New England Journal of Medicine" reported a breakthrough of using CAR T-cell therapy for systemic lupus erythematosus (SLE) by The First Affiliated Hospital of University of Science and Technology of China. It establishes the treatment's clinical feasibility, offering hope for patients with refractory SLE.

For international patients, the choice is often pragmatic. While the technological expertise is comparable to global standards, the significant cost-effectiveness is a major factor. 

In August, the patient reached out to the hospital's cancer center, initiating a remote consultation before traveling to Shanghai. He cited his own research, the hospital's excellent communication, and the experience from another New Zealand patient treated in China as key factors in his decision.

Treatment and outlook

The treatment process is structured in two main stages. The first stage, in mid-September, was a one-week stay for T-cell harvesting.

Prior to the patient's departure, the medical team outlined a series of required pre-travel tests to ensure that the patient was medically fit for air travel. They also reviewed the patient's regular medication regimen and developed an adjusted schedule. 

This plan was designed to ensure that upon arrival in Shanghai, the patient would be optimally prepared for a successful T-cell collection, according to Dr Xuan Linli, chief of medical oncology.

The patient returned to Shanghai in October for the CAR-T infusion. This second stage lasted 21 days, allowing the medical team to closely monitor him for potential side effects.

The most challenging part of the process was managing the side effects of the therapy. "Getting through the Cytokine Release Syndrome, at 72 hours, I was quite sick," the patient recalled. 

Often referred to as a "cytokine storm," Cytokine Release Syndrome is the dangerous inflammatory overdrive of the immune system that is a direct consequence of the very power that makes immunotherapies effective.

However, the initial blood tests following the infusion have been positive. "The blood tests I've had here have shown that [the CAR-T] is working," he stated.

He also expressed surprise at the quality of care. "I didn't know what to expect. I've been very impressed. It's as good as anywhere in the world," he said, noting that the specific CAR-T infusion drug he received was developed in China. "This is state-of-the-art treatment. Nothing better in the world."