CAR-T therapy gives patient options after cancer returns

When Sabrina Shelton exhausted traditional treatment options, her care team at UVA referred her to UNC Lineberger’s Matthew Foster, MD, for a chimeric antigen receptor T-cell (CAR-T) therapy clinical trial. Watch the video and read the story about her journey.

February 25, 2020

When Sabrina Shelton received her college degree in 2007, her thoughts were focused on her future. She considered grad school and going straight into the workforce, looking for housing and starting salaries, but what she didn’t expect was a cancer diagnosis.

In April of 2008, Shelton, now 34, of Bedford, Virginia, was diagnosed with acute lymphoblastic leukemia, derailing her plans for the next phase of her life and fast tracking her into a month of cancer treatment, followed by a year of after care.

“At the time, you’re asking yourself, ‘What do I want to do? What do I want?’ ” she said. “It’s the kind of existential question that we’re all asking ourselves as we graduated college, and then you get your answer.”

For Shelton, her cancer journey started off smoothly. She was in remission within a month of starting treatment and was cancer-free for almost five years — a standard cancer survivorship benchmark. But her cancer returned in 2012 and again in 2014. And still again in 2018.

“I just wanted to get to that five-year mark so bad,” Shelton said. “I was of course upset about it and disappointed that it didn’t at least get me to the five-year mark, because that’s the target number that I wanted. With every recurrence, I do have those moments where when I initially hear about it, I’m shocked.”

The bulk of Shelton’s care had been at the University of Virginia Cancer Center, with the exception of a stem cell transplant with UNC Lineberger‘s Paul Armistead, MD. With her recurrence in 2018, she had exhausted traditional treatment options, so Shelton’s care team referred her to UNC Lineberger’s Matthew Foster, MD, for a chimeric antigen receptor T-cell (CAR-T) therapy clinical trial.

CAR-T immunotherapy uses a patient’s own immune system to fight their cancer. This involves extracting the patient’s T-cells, manipulating them to recognize the patient’s cancer, and then re-infusing them into the patient to attack their cancer cells.

“One advantage of these altered T-cells is that they can survive and persist within the body and, not only be an army of cells for one time, but an occupying force,” Foster said.

At the North Carolina Cancer Hospital clinic in Chapel Hill, Foster was both optimistic and realistic about Shelton’s prognosis, taking time to answer her questions. CAR-T being a relatively new treatment, however, there were not a lot of outcomes and results he could share with Shelton, a self-proclaimed “numbers person.”

“I want to know how many people have had it, how many have survived, how long has it lasted?” she said. “And they just can’t tell me it’s going to last short term or long term. But the clinical trial itself went way better than I had imagined in my mind of how it would go.”

Foster and the cellular immunotherapy team at UNC Lineberger look for new treatments for difficult-to-treat cancers, and Shelton was part of the corresponding study that aimed to make treatments safer.

“Fortunately, she had an easier pathway with these CAR-T therapies than she did with her transplant,” Foster said. “That’s not necessarily true for all patients. There are patients who have had more profound toxicities.”

For Shelton, the difference in treatment strategies was significant. With CAR-T, she didn’t suffer the same types of side effects she had with chemotherapy and radiation or the lengthy hospital stay and recovery with the stem cell transplant. There was no hair loss; no mouth sores; no bone-deep fatigue. She said her real fear was neurological effects from the CAR-T treatment, but her cognition was unaffected.

“The only major thing I’ve had was a fever. I never had any of the hallucinations or the other major neurological symptoms,” she said. “For that to be the biggest side effect that I had, I was certainly blessed.”

“We see a number of young adults and adolescents with acute lymphoblastic leukemia. Unfortunately, this population is often in the midst of launching themselves from under their parents’ wings and launching their careers or education,” Foster said. “Sometimes the parents take an active role, and sometimes the parents don’t. Sabrina is fortunate to have supportive parents and a great attitude herself in terms of taking care of herself and trying to blend her care for herself with her career aspirations and personal life.”

These days, Shelton’s focus is on her life outside of cancer. She enjoys volunteering at a bridal shop that receives donated dresses from high-end shops like Kleinfeld Bridal in New York and gives the proceeds to help women in need. She recently took trips to Colorado and California. She’s even planning to go to New York — something she couldn’t imagine doing during her initial diagnosis and recurrence.

“I see everybody else around me living life. So, I feel like, ‘why can’t I?’ ” she said. “Of course, life can happen in between all of these plans, but I’m just not going to sit back and watch life pass me. I’m going to get out there as much as I possibly can.”

Learn more about the CAR-T Immunotherapy Program at UNC Lineberger.

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