In 2017, CAR-T therapy made waves as the first gene therapy to be approved by the Food and Drug Administration.

In a fascinating article for Undark, Ilana Yurkiewicz, a physician at Stanford University, plunges into the fraught history and future of a cancer treatment that’s as radical as it is risky.

Unlike chemotherapy or radiation, which attack cancer directly, CAR-T engineers patients’ immune cells so they can do it themselves. T-cells are removed from the blood and given new genes that produce receptors that let the T-cells recognize and bind to leukemia cells with a specific protein, CD19.

The genetically modified T-cells are then multiplied in the lab and infused back into the patient, where they ideally multiply even further and begin to target and kill cancer cells with CD19.

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Today, there are two CAR-T therapies on the market: Kymirah and Yescarta. But the availability of the drugs doesn’t mean they’re ideal for all patients, or without side effects. Patients who use the new treatment are susceptible to headaches, seizures and other neurological symptoms, some severe. The treatment is also extremely expensive, and those qualified for treatment are often close to death.

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Yurkiewicz explores these issues, explains why they are only used in patients with certain cancers — some leukemias and lymphomas — and probes questions about why they haven’t yet been shown to work against solid tumors.

Yurkiewicz isn’t just a physician: She’s also a journalist, and she weaves a story that’s as intriguing as it is informative.

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From the story of the therapy’s fraught first clinical trial to accounts of patients who gambled against death, hers is a deeply human tale of hope, research and the potentially perilous path to recovery for patients who choose CAR-T, which stands for chimeric antigen receptor T-cell.

“Hoping for a miracle while preparing to die are mutually compatible ideas,” writes Yurkiewicz. “For an adversary as tough as cancer, we’ll take any tool we can get.”

You can read her feature online at bit.ly/UndarkCAR-T.

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