When we talk about treatment outcomes in cancer patients, two terms are often used: “remission” and “cure”. O g1 listened to experts to explain the difference between these concepts.
According to Rodrigo Calado, professor of hematology at the USP’s Ribeirão Preto School of Medicine, the cure is that the cancer is completely eradicated. But you can only know that after at least five years without symptoms of illness. Before that, the correct term is “remission”.
“Remission is when no test detects the cancer. It may have been healed, but it could also have declined a lot and the methods available can’t detect it, but it hasn’t completely disappeared. We The cancer simply cannot be detected. Therefore, the patient must continue to be monitored and tests performed to check if there are signs of the tumor, no matter how small.”
Vanderson Rocha, professor of hematology, hemotherapy and cell therapy at USP Medical School and national coordinator for cell therapy at the D’Or network, says the patient is in remission must first undergo physical examinations every three months, four months, six months and then once a year.
“Immediately after that you have to be careful with an infection. It depends a lot on the type of treatment, but in general life is normal three months after remission. A bone marrow transplant takes about six months, depending on the type of transplant. “Normal life, do what you want in moderation,” he stresses.
CAR-T cell
So far, 14 patients have been treated with CAR-T cells in the study, which is funded by the Sao Paulo State Research Foundation (Fapesp) and the National Council for Scientific and Technological Development (CNPq). Recovery was in the Unified Health System (SUS). A The therapy fights the disease with the patient’s own immune cells modified in the laboratory.
The Brazilian version of the technique is used in a compassionate way in Brazil by USP in collaboration with the Butantane Institute and Blood Center of Ribeirão Preto, when the study admits the patient at an advanced stage of the disease and the doctors receive approval from Anvisa for the application of the method.
“In patients, we use some cancer screening tests, such as PET-CT (contrast-enhanced tomography) or blood tests, to detect the DNA of the cancer,” says Rodrigo Calado, associate professor of hematology at USP.
“Of the American cases that started 10 years ago, many are cured, more than 50%. And these are patients who have not responded to several previous treatments, the disease has come back several times. So this is very significant, even if “50%” completed.
All patients treated in the study experienced remission of at least 60% of their tumors. Recovery was in the Unified Health System (SUS).
O The CAR-T cell method targets three types of cancer: B-lymphoblastic leukemia, B-cell non-Hodgkin’s lymphoma and multiple myelomathat reaches the bone marrow. There is still no treatment for multiple myeloma in the country.
The technology is used in a few countries. In Brazil, 75 patients are to be treated with public funds after Anvisa approval for the clinical study with CAR-T cells in the second half of the year (Read more below). Currently, the treatment is only available in the Brazilian private network and costs at least R$ 2 million per person.
Paulo Peregrino
The 61-year-old recruiter is the youngest case of a short-term complete remission in the study group of 14 patients at the cell therapy center.
Paulo was released on Sunday (28) after receiving medical attention at the Hospital das Clínicas in the city of São Paulo.
“The victory is not mine alone. It comes from faith, science and the positive energy of people. Each of them helped launch a parallelepiped on this path. The picture shows everyone very clearly how serious my lymphoma is and I had no idea it was.”
Vanderson Rocha is in charge of Paulo’s case and was surprised by the response to treatment.
“It was a very quick reaction and with so much tumor. i get emotional [ao ver as duas ressonâncias de Paulo]. When we saw it, everyone cheered. I accepted him into the group of tenured professors at USP and everyone was impressed by the response he got,” said the specialist happily.
Before and after
The two Pet Scan images (CT with special contrast) (see above) represent “two Paulos”: the left, the patient whose only path was palliative care when the alternative is to offer comfort but not expect healing, and the right, a patient with a body that has no tumors after surgery. CAR-T cell treatment.
- Car-T Cell: Understanding experimentally applied cancer cell therapy
By the time the doctor had contact with Paulo, the publicist had already undergone surgery, dozens of tests and chemotherapy.
You can find out which cell therapy is used against cancer in a study on the public network
13 years “playing forward”
A timeline helps guide the comings and goings of Paulo’s tumors. The story is told in an autobiography still in production entitled A Vida pelo Copo D’água, in which he mentions his medicine: “Faith and science to live the full half of life”.
Internet research led the family to CAR T cell treatment and doctor Vanderson Rocha.
“I started accompanying him when I was already through most of the treatment. The disease returned, so his last option was actually CAR-T cells. I had to get permission from Anvisa for us to do this type of treatment. “Many patients do not have this option,” explained the specialist.
Patient with cancer for 13 years achieved complete remission of SP within 1 month of cell therapy in public health study
“Study object”
Physical education teacher Bruno Marques Giovanni is another patient in the study group Paulo is attending. A year and a half ago, the physical education teacher returned to his everyday life after leaving the Hospital das Clínicas in Ribeirão Preto. For three years he battled an aggressive leukemia that pushed for a return.
She and the other cancer patients can only be considered cured five years after the tumors have disappeared. Until then, Bruno returns to the hospital for tests every three months.
“Because it is an innovative treatment, a business that is still being studied and evolving, I am happy to go there to undergo these tests so that they can see everything that is happening. Because I know in quotes I am a study subject but a person who is doing very well. I just always thank the whole team.”
CAR-T cell in SUS
In 2021, the group partnered with the Butantan Institute and set up two factories in the state, one in the Cidade Universitária in São Paulo and another in the university campus of Ribeirão Preto with the initial production capacity of 300 treatments per year.
“In order to make it accessible to the Brazilian population, it is necessary to obtain funds for the treatment of 75 patients with lymphoma and leukemia and to generate the clinical data that will allow the product to be registered with Anvisa,” explained Dimas.
“This clinical trial will cost BRL 60 million but will save BRL 140 million compared to the prices charged by private companies. We recently submitted the project to the Ministry of Health and expect support and funding to advance this important technology in the country, which could launch a new biotechnology industry,” he added.
The forecast assumes that the study will start in August of this year.
“There’s already a queue of patients because the doctors, who already know we’re in this process, are constantly sending people’s names and because of requests, those names get queued up.”
What does Anvisa say?
The agency informed that g1 which gave priority to the analyzes of the study.
“Anvisa has received a clinical trial proposal conducted by CEPID-FAPESP-USP and this application is currently under review by Anvisa. The request is part of a pilot project where Anvisa has selected the cell therapy center (CEPID-FAPESP-USP) in Ribeirão Preto to collaborate on the development of advanced therapy products in Brazil. Therefore, the agency was in dialogue with the CEPID-FAPESP-USP development team to improve the study design. CEPID-FAPESP-USP has also established a schedule with Anvisa to send information about the possible manufacture of the product and the controls in force in the coming months. In turn, Anvisa has prioritized these analyzes and provided rapid feedback to the developer with the aim of prioritizing the conduct of this study in Brazil.”