Learn how our scientists are using this innovative immunotherapy — a type of living drug — to offer patients hope.
What is CAR T?
Your own body is one of your best defenses against cancer. Memorial Sloan Kettering scientists are learning how to harness the power of the body’s immune system to fight cancer, an approach called immunotherapy.
Racing to the front of the pack is a type of immunotherapy called chimeric antigen receptor (CAR) T cell therapy. In this approach, immune cells are removed from a patient, armed with new proteins that allow them to recognize cancer, and given back to the patient in large numbers. These cells persist in the body, becoming “living drugs.”
MSK scientists pioneered this approach, and they are working hard to improve and expand it. See how this treatment works.
Hear from a patient who has benefited from CAR T.
- MSK is currently running CAR T-focused clinical trials for several different types of cancer.
- MSK scientists pioneered CAR T cell therapy for cancer.
- More than 80 percent of acute leukemia patients treated with CD19-directed CARs at MSK have seen their cancer regress.
- MSK scientists were the first to show that CD19 was a good target for CAR T cells.
- MSK scientists are exploring ways to make CAR T cell therapy safer, with fewer side effects.
- Call 1-888-MSK-CART to learn more about treatment for certain blood cancers.
Expert Patient Care
Our doctors and nurses have unparalleled expertise in caring for patients who are receiving this treatment. There are risks associated with receiving CAR T cells, but our clinicians — including members of the Cellular Therapeutics Center and the Bone Marrow Transplant Service — have vast experience in managing side effects, which are usually reversible.
CAR T cell therapy has proven very effective at treating acute lymphoblastic leukemia (ALL) in both children and adults. This type of blood cancer is usually treated successfully with chemotherapy, but in some cases conventional approaches do not work. That’s when CAR T cell therapy can be a patient’s best option.
When chemotherapy couldn’t get Esmeralda Pineda’s pediatric leukemia under control, doctors at Memorial Sloan Kettering turned to immunotherapy. The successful treatment wiped out all signs of her disease, and one year later, she’s still cancer free. Read Ezzy’s story
When avid golfer Karen Koehler was sidelined by cancer, CAR T immunotherapy got her back in full swing. Read Karen’s story
CAR T cells are also being explored as a treatment for several other types of cancer, including lymphoma, lung cancer, breast cancer, mesothelioma, ovarian cancer, and multiple myeloma. To search for an open CAR T trial at MSK, visit our clinical trial database.
Find out more about receiving CAR T cell treatment at Memorial Sloan Kettering.
Putting CARs on the Road
In the early 1990s, the techniques to introduce genes into cells were just being developed. Dr. Sadelain wanted to use the new techniques to engineer T cells, giving them souped-up capabilities.
“At the time it sounded very pipe dream,” one of Dr. Sadelain’s doctoral thesis advisers told the New York Times. But Dr. Sadelain “believed in his approach and he pursued it relentlessly.”
A decade later, in 2002, Dr. Sadelain and his MSK colleagues, including Isabelle Rivière and Renier Brentjens, published a now seminal article showing that T cells engineered with a chimeric antigen receptor could kill tumor cells and persist in the body. They were also the first ones to show that targeting a marker called CD19, found on the surface of blood cells, was a good way to kill leukemia and lymphoma.
The FDA granted CD19 CAR T cells a Breakthrough Therapy designation for relapsed or refractory ALL in 2014. “CAR T cells are making history, beyond any doubt,” Dr. Sadelain says.
Timeline of Progress
Click right to see how CAR T science developed and what MSK investigators contributed to this important field.
—Immune cells shown to protect mice from cancer
Scientists show that immune cells can kill cancer in mice. The exact cell types involved are not completely understood.
—Origin of T cells discovered
Immunologist Jacques Miller, while studying for his PhD at the University of London, identifies the thymus gland as the place where T cells develop.
—Bone marrow transplants used in cancer treatment
MSK scientists use bone marrow stem cells from an unrelated donor to replenish a patient's blood cells after intensive chemotherapy. T cells from the donor kill cancer cells in the recipient. Many consider this to be one of the first successful immunotherapies.
—Tumor-infiltrating lymphocytes used to treat cancer
Steven Rosenberg and colleagues at the Surgery Branch of the National Cancer Institute treat patients with tumor-infiltrating lymphocytes. These cells are removed from a tumor and expanded in the lab before being given back to the patient in large numbers. A few patients are cured of advanced cancer, showing that a person's own immune cells can fight cancer.
—T cell engineering begins
As a postdoctoral student at the Whitehead Institute at MIT, immunologist Michel Sadelain begins using newly developed genetic engineering tools, specifically retroviral vectors, to introduce genes into T cells, with the goal of making souped-up cancer fighters. This idea would bear fruit in the coming years.
—First-generation CARs developed
Immunologist Zelig Eshhar, of the Weizmann Institute in Israel, engineers T cells with the first chimeric molecule, a portion of an antibody fused to part of a T cell receptor. These will become known as first-generation CARs. While technologically innovative, these early CARs do not persist in the body and are not clinically effective.
—Antigen-specific T cells used in humans
The field takes a step forward when MSK scientists learn to isolate virus-specific T cells for use in stem cell transplants. These cells help prevent post-transplant infections and virally caused cancers in patients, and also limit graft-versus-host disease, a dangerous side effect.
—Co-stimulation shown to provide a necessary boost
Dr. Sadelain and colleagues show that introducing a co-stimulatory molecule (in this case CD28) into engineered T cells allows them to persist and remain active in the body, setting the stage for a new generation of CARs.
—First effective CAR T cells developed
The MSK team builds the first effective CAR T cells, targeted against a prostate cancer antigen. These second-generation CARs T cells are able to survive, proliferate, and kill prostate cancer cells in the lab, establishing the feasibility of CAR T cell therapy. An even more promising CAR target lay ahead.
—Second-generation CARs built to target CD19
Dr. Sadelain and colleagues publish a seminal paper showing that human CD19-directed CAR T cells can kill leukemia cells in a mouse model. This is the first time that CD19 is shown to be an effective target for CAR T cells. The field quickly follows suit.
—Recipe for CD19 CARs published
Dr. Sadelain and colleagues, including Isabelle Rivière, publish details of their manufacturing process for CD19 CAR T cells, to be used in patients with relapsed, chemorefractory leukemia. They show that the manufacturing process works and the cells are effective.
—Coley Award given for CAR T cell therapy
The Cancer Research Institute bestows the 2012 Coley Award for Tumor Immunology, jointly, to Michel Sadelain of MSK and Carl June of the University of Pennsylvania for their work contributing to the development of CAR T therapy.
—Results of CAR T leukemia clinical trial published
MSK physician-scientist Renier Brentjens and colleagues publish results of a clinical trial using CD19 CAR T cells in adults with acute lymphoblastic leukemia (ALL). This is the first published study using CARs to treat ALL in humans.
—Cancer immunotherapy voted "Breakthrough of the Year"
Science magazine votes cancer immunotherapy the 2013 "Breakthrough of the Year." Among the approaches discussed is CAR T cell therapy.
—FDA designates CARs a "breakthrough" therapy
The FDA grants Breakthrough Designation status to CD19-directed CAR T cells, signaling the field's scientific and clinical progress.
—Mesothelin-directed CARs developed
MSK physician-scientist Prasad Adusumilli publishes results on CARs built to recognize an antigen on solid tumors called mesothelin. Solid tumors require a different approach since they do not make CD19.
—Armored CARs developed
—CRISPR'd CARs built
Dr. Sadelain and colleagues show that the genome-editing tool CRISPR can be used to place a CAR at a specific genetic location in T cells, for improved functioning.
—First CARs cross the regulatory finish line
The FDA approves CD19-directed CAR T cells for the treatment of relapsed, refractory acute lymphoblastic leukemia in children and young adults.
Manufacturing Living Drugs
Using cells as drugs requires a sterile facility that can manufacture these sophisticated cellular products under strict controls. MSK has an entire core facility devoted to this vital task.
Administering investigational CAR T cells safely and effectively is the job of members of MSK’s Cellular Therapeutics Center, led by physician-scientist Renier Brentjens. From designing clinical trials to working with other centers to establish CAR T programs, the members of this center are leaders in the clinical application of CARs.
The scientists and clinicians associated with the CAR T program at MSK work together to provide seamless care for patients. New models of CAR T cells are designed, built, and tested right here at MSK.
CARs in the News
The following is a selection of media articles and videos about CAR T therapy:
- Gene Therapy Will Transform Medicine. BBC Two. June 19, 2017.
- Immunotherapy: The next frontier in cancer treatment. CBS News. March 12, 2017.
- CRISPR Turbocharges CAR T Cells, Boosts Cancer Immunotherapy. Genetic Engineering and Biotechnology News. February 23, 2017.
- Setting the Body’s ‘Serial Killers’ Loose on Cancer. New York Times. August 1, 2016.
- Biotech’s Coming Cancer Cure. MIT Technology Review. June 18, 2015.
- The CAR T-Cell Race. The Scientist. April 1, 2015
For media inquires, please visit our pressroom.