06th July 2019
Four years ago, Tanya Hill’s life was panning out almost perfectly. She had recently completed a master’s degree in crime and forensic science, and had taken the summer off “to go to festivals and join the gym”. In the autumn of 2015 she was preparing to send out her CV to get “a hotshot job in London” when, after a weekend away to celebrate her 25th birthday, her world fell apart. She had been taking the drug Roaccutane, an acne treatment that required routine blood tests to check for side-effects such as liver problems. One morning she had a missed call from the GP who she usually called to check her results. “I remember the day like it was yesterday,” she says. “We had got up to go the gym when I saw the doctor’s number on my phone. Brendon insisted I call back and with that call everything changed.”
Diagnosed with acute lymphoblastic leukaemia — an aggressive cancer of the white blood cells — her life became an endless round of hospital visits and treatments. Three rounds of chemotherapy were unsuccessful and by May 2016 she was told she needed a stem cell transplant. One of her brothers was a 100 per cent match, but the procedure didn’t work and in 2017 she relapsed. “I then went on a new drug called inotuzumab that targets cancer cells, but leaves healthy cells alone, and that got me into remission,” she says. “But I was told that was temporary and there was no guarantee it wouldn’t come back.” It was at that point that her consultant at Addenbrooke’s Hospital in Cambridge recommended her for a clinical trial at UCLH using Car-T therapy (chimeric antigen receptor), a ground-breaking type of immunotherapy that involves using a patients’ immune cells to treat their condition.
In what sounds like a sci-fi experiment, the procedure — sometimes described as a type of “living drug” — is highly complex. Millions of a patient’s T-cells, the fighters of the immune system, are extracted from their blood and genetically reprogrammed to attack cancer cells, multiplied and, when turbocharged, reintroduced to the patient’s veins over several days.
The T-cells in our bodies work like little robots looking for infected cells and killing them, but they don’t normally find cancer cells because they come from within our own bodies.Dr Martin Pule, a senior lecturer in haematology at the UCL Cancer Institute, where Tanya was treated.
The T-cells can be taken from the body with no ill effect. “Our job is to reprogramme them with an artificial gene that means they can detect cancer cells in the body,” he says. “They then hunt around as normal looking for the cancer cells to kill and the T-cells start to make copies of themselves.”
With T-cells circulating in their bloodstream like cancer serial killers, patients who have exhausted other treatments and medical options often see a staggering change in their prognosis. A single genetically altered T-cell can destroy up to 100,000 cancer cells. Pule, who has headed the largest European clinical trials into immune cells, says it is an area of medical research that has exploded in the past decade. “It has gone from being considered this slightly eccentric area — there was nothing like it in oncology — to one that has produced particular success in childhood leukaemia,” he says. When it is successful it can bring remission that lasts for many years.
Car-T therapy has been found to work only for certain types of blood cancers — it is already provided on the NHS for children and young adults with B-cell acute lymphoblastic leukaemia, and the National Institute for Health and Care Excellence recommends it for adults with B-cell lymphoma — but the potential is huge. Early studies suggest it could be used to treat solid tumours that are notoriously hostile and difficult for the body’s T-cells to attack. “The most promising data is on leukaemia, but exploration is under way at UCL to look at the effects of solid cancers, and other researchers are looking at how it works with brain cancer,” Pule says. “There also has been early success with bone marrow cancer.”
It doesn’t work for everyone (some studies suggest it is successful in less than than 50 per cent of patients) and there can be side-effects, including brain swelling and toxicity. “Sometimes when it doesn’t work, the T-cells are unable to see the leukaemia any more,” Pule says. “In general, the experience depends on how much disease is on board and, on average, people undergoing it have a bad case of a flu-like syndrome with a high temperature and shaking.” Tanya had none of that. When she went to UCLH for her Car-T therapy, she says it didn’t feel as though she was having cancer treatment at all. “I got a little bit tired and my feet were swollen one day, but other than that it felt like an eight-day holiday in London,” she says. “Compared to everything else I had been through, I felt at that point that I was getting better.”
Nearly two years on she has had no side-effects and has been reduced to three-monthly check-ups. She has been told these could be cut to six-monthly appointments after she returns from her honeymoon in October.
My energy is returning to the levels I had before cancer. And while my body has changed — I am more sensitive to everything and I’ve found I’ve got allergies that I never previously had — I don’t think I look much different.Tanya
She works out daily at the gym attached to the café, has run a marathon and is working as a dog walker, although she hopes to use her degree in the future. “I had chemo brain for a long time and it leaves you confused and sensitive to noise, unable to string words together,” she says. “But that has got much better.”
Could Car-T eventually replace chemo as a treatment for cancer? Pule says the field is still young, but with hundreds of clinical trials under way, that possibility is real. “It’s challenging to reach that point, but we are closer,” he says. “There’s a lot of regulatory stuff and technical bureaucracy to get through and an overwhelming amount of work to be done.” His inspiration comes from the patients. “We heard from one of them just the other day and they had run a marathon,” Pule says. “These people are amazing.”
Tanya is undoubtedly one of them. She and Brendon are planning a move to the coast, and eventually hope to have children with the nine embryos they stored before she underwent some of her treatment. “I wouldn’t wish cancer on anyone, but it’s almost easier having the disease than being the person close to you without it,” she says. “I’m the one with the cancer, so I can be proactive and do want I want, feel how I want about it. Your family and people close to you have a much harder time. It has completely changed my perspective on everything. And right now, life is very good.
This article has been adapted from The Times, where you can read the full piece.