One year of CAR-T therapy: Advancing personalized cancer treatment at Geisinger
Authors: Lori Stopper, RPh, PharmD, Kayla Aufiero, RPh, PharmD
Geisinger Medical Center in Danville and the Geisinger Cancer Institute have successfully completed the first year of chimeric antigen receptor T-cell (CAR-T) therapy infusions, treating 12 patients with the goal of achieving long-term remission — or even a potential cure — for cancers that are traditionally resistant to treatment. This milestone marks a significant advancement in personalized cancer care and reflects the dedication of multidisciplinary teams committed to improving patient outcomes.
CAR-T cell therapy is a highly specialized form of immunotherapy designed to treat certain types of blood cancers by harnessing the power of the patient’s own immune system. The process begins with the collection of T cells — a type of white blood cell — through leukapheresis.
These cells are then genetically modified in a laboratory to express chimeric antigen receptors (CARs), which enable them to recognize and target specific proteins found on cancer cells. Once modified, the CAR-T cells are infused back into the patient, where they actively seek out and destroy cancer cells carrying the targeted antigen.
Geisinger’s formulary includes 5 CAR-T therapies:
• Tecartus® (for relapsed/refractory acute lymphoblastic leukemia and mantle cell lymphoma)
• Yescarta® (for relapsed/refractory follicular lymphoma and large B-cell lymphoma)
• Abecma® (for relapsed/refractory multiple myeloma)
• Breyanzi® (for relapsed/refractory chronic lymphocytic leukemia, follicular lymphoma, large B-cell lymphoma and mantle cell lymphoma)
• Kymriah® (for relapsed/refractory acute lymphoblastic leukemia, diffuse large B-cell lymphoma and follicular lymphoma)
All patients treated experienced cytokine release syndrome (CRS), with severity limited to grade 1 or 2. Tocilizumab is administered with approval from the hematology attending for grade 1 CRS with persistent or refractory fever, and for grades 2 through 4. To date, 2 patients received 4 doses of tocilizumab, 1 patient received 3 doses, and 3 patients received 2 doses.
Immune effector cell-associated neurotoxicity syndrome (ICANS) occurred in 5 patients. Of these, 1 experienced grade 1 symptoms, 3 experienced grade 2 symptoms, and 1 patient passed away before ICANS could be resolved. Steroids are used as the first-line treatment for ICANS, also requiring approval from the hematology attending.
To date, 3 patients have passed away following CAR-T therapy due to complications including fungemia with pancytopenia, recurrence of disease and renal failure. The remaining patients are doing well, with no major deficits reported.
Pharmacists play a critical role in the care of CAR-T patients. Prior to admission, pharmacists contact patients to conduct a comprehensive medication reconciliation. Before discharge, every patient and their caregiver receives counseling on discharge medications. Post-discharge, the medication therapy management clinic closely monitors each patient to ensure adherence to antimicrobial prophylaxis, CAR-T medication protocols and the vaccination schedule associated with CAR-T therapy.
