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A “living drug” that could change the way we treat cancer | Carl June

A “living drug” that could change the way we treat cancer | Carl June

So this is the first time
I’ve told this story in public, the personal aspects of it. Yogi Berra was a world-famous
baseball player who said, “If you come to a fork
in the road, take it.” Researchers had been,
for more than a century, studying the immune system
as a way to fight cancer, and cancer vaccines have,
unfortunately, been disappointing. They’ve only worked in cancers
caused by viruses, like cervical cancer or liver cancer. So cancer researchers basically
gave up on the idea of using the immune system
to fight cancer. And the immune system, in any case,
did not evolve to fight cancer; it evolved to fight pathogens
invading from the outside. So its job is to kill
bacteria and viruses. And the reason the immune system
has trouble with most cancers is that it doesn’t invade
from the outside; it evolves from its own cells. And so either the immune system does
not recognize the cancer as a problem, or it attacks a cancer
and also our normal cells, leading to autoimmune diseases
like colitis or multiple sclerosis. So how do you get around that? Our answer turned out to be
synthetic immune systems that are designed to recognize
and kill cancer cells. That’s right — I said
a synthetic immune system. You do that with genetic engineering
and synthetic biology. We did it with the naturally occurring
parts of the immune system, called B cells and T cells. These were our building blocks. T cells have evolved to kill
cells infected with viruses, and B cells are the cells that make
antibodies that are secreted and then bind to kill bacteria. Well, what if you combined
these two functions in a way that was designed
to repurpose them to fight cancer? We realized it would be possible
to insert the genes for antibodies from B cells into T cells. So how do you do that? Well, we used an HIV virus
as a Trojan horse to get past the T cells’ immune system. The result is a chimera, a fantastic fire-breathing creature
from Greek mythology, with a lion’s head, a goat’s body
and a serpent’s tail. So we decided that the paradoxical
thing that we had created with our B-cell antibodies,
our T cells carrier and the HIV Trojan horse should be called “Chimeric Antigen
Receptor T cells,” or CAR T cells. The virus also inserts genetic information to activate the T cells and program them
into their killing mode. So when CAR T cells are injected
into somebody with cancer, what happens when those CAR T cells
see and bind to their tumor target? They act like supercharged killer
T cells on steroids. They start this crash-defense
buildup system in the body and literally divide
and multiply by the millions, where they then attack and kill the tumor. All of this means that CAR T cells
are the first living drug in medicine. CAR T cells break the mold. Unlike normal drugs that you take — they do their job and get metabolized,
and then you have to take them again — CAR T cells stay alive
and on the job for years. We have had CAR T cells stay
in the bodies of our cancer patients now for more than eight years. And these designer
cancer T cells, CAR T cells, have a calculated half-life
of more than 17 years. So one infusion can do the job; they stay on patrol
for the rest of your life. This is the beginning
of a new paradigm in medicine. Now, there was one major challenge
to these T-cell infusions. The only source of T cells
that will work in a patient are your own T cells, unless you happen to have
an identical twin. So for most of us, we’re out of luck. So what we did was to make CAR T cells. We had to learn to grow
the patient’s own T cells. And we developed a robust
platform for this in the 1990s. Then in 1997, we first tested
CAR T cells in patients with advanced HIV-AIDS. And we found that those CAR T cells
survived in the patients for more than a decade. And it improved their immune system
and decreased their viruses, but it didn’t cure them. So we went back to the laboratory,
and over the next decade made improvements
to the CAR T cell design. And by 2010, we began treating
leukemia patients. And our team treated three patients with advanced chronic
lymphocytic leukemia in 2012. It’s a form of incurable leukemia that afflicts approximately 20,000 adults
every year in the United States. The first patient that we treated
was a retired Marine sergeant and a prison corrections officer. He had only weeks to live and had, in fact, already paid
for his funeral. The cells were infused,
and within days, he had high fevers. He developed multiple organ failures, was transferred to the ICU
and was comatose. We thought he would die, and, in fact, he was given last rites. But then, another
fork in the road happened. So, around 28 days after
the CAR T cell infusion, he woke up, and the physicians finally examined him, and the cancer was gone. The big masses that
had been there had melted. Bone marrow biopsies found
no evidence of leukemia, and that year, in our first
three patients we treated, two of three have had durable remissions
now for eight years, and one had a partial remission. The CAR T cells had attacked
the leukemia in these patients and had dissolved between 2.9
and 7.7 pounds of tumor in each patient. Their bodies had become veritable
bioreactors for these CAR T cells, producing millions
and millions of CAR T cells in the bone marrow,
blood and tumor masses. And we discovered that these CAR T cells
can punch far above their weight class, to use a boxing analogy. Just one CAR T cell can kill
1,000 tumor cells. That’s right — it’s a ratio
of one to a thousand. The CAR T cell and
its daughter progeny cells can divide and divide
and divide in the body until the last tumor cell is gone. There’s no precedent for this
in cancer medicine. The first two patients
who had full remission remain today leukemia-free, and we think they are cured. These are people
who had run out of options, and by all traditional methods they had, they were like modern-day Lazarus cases. All I can say is: thank goodness
for those forks in the road. Our next step was to get permission
to treat children with acute leukemia, the most common form of cancer in kids. The first patient we enrolled
on the trial was Emily Whitehead, and at that time, she was six years old. She had gone through
a series of chemotherapy and radiation treatments
over several years, and her leukemia had always come back. In fact, it had come back three times. When we first saw her, Emily was very ill. Her official diagnosis
was advanced, incurable leukemia. Cancer had invaded her bone marrow,
her liver, her spleen. And when we infused her
with the CAR T cells in the spring of April 2012, over the next few days,
she did not get better. She got worse, and in fact, much worse. As our prison corrections
officer had in 2010, she, in 2012, was admitted to the ICU, and this was the scariest fork
in the whole road of this story. By day three, she was comatose
and on life support for kidney failure, lung failure and coma. Her fever was as high
as 106 degrees Fahrenheit for three days. And we didn’t know
what was causing those fevers. We did all the standard
blood tests for infections, and we could not find
an infectious cause for her fever. But we did find something
very unusual in her blood that had never been seen
before in medicine. She had elevated levels of a protein
called interleukin-6, or IL-6, in her blood. It was, in fact, more than a thousandfold
above the normal levels. And here’s where yet another
fork in the road came in. By sheer coincidence, one of my daughters has a form
of pediatric arthritis. And as a result, I had been
following as a cancer doc, experimental therapies
for arthritis for my daughter, in case she would need them. And it so happened that just months
before Emily was admitted to the hospital, a new therapy had been approved by the FDA to treat elevated levels of interleukin-6. And it was approved for the arthritis
that my daughter had. It’s called tocilizumab. And, in fact, it had just been added
to the pharmacy at Emily’s hospital, for arthritis. So when we found Emily had
these very high levels of IL-6, I called her doctors in the ICU and said, “Why don’t you treat her
with this arthritis drug?” They said I was a cowboy
for suggesting that. And since her fever and low blood pressure had not responded to any other therapy, her doctor quickly asked permission
to the institutional review board, her parents, and everybody, of course, said yes. And they tried it, and the results were nothing
short of striking. Within hours after treatment
with tocilizumab, Emily began to improve very rapidly. Twenty-three days after her treatment, she was declared cancer-free. And today, she’s 12 years old
and still in remission. (Applause) So we now call this violent reaction
of the high fevers and coma, following CAR T cells, cytokine release syndrome, or CRS. We’ve found that it occurs in nearly
all patients who respond to the therapy. But it does not happen
in those patients who fail to respond. So paradoxically, our patients now hope
for these high fevers after therapy, which feels like
“the worst flu in their life,” when they get CAR T-cell therapies. They hope for this reaction because they know it’s part
of the twisting and turning path back to health. Unfortunately, not every patient recovers. Patients who do not get CRS
are often those who are not cured. So there’s a strong link now between CRS and the ability of the immune system
to eradicate leukemia. That’s why last summer, when the FDA approved
CAR T cells for leukemia, they also co-approved the use
of tocilizumab to block the IL-6 effects and the accompanying CRS
in these patients. That was a very unusual event
in medical history. Emily’s doctors have now
completed further trials and reported that 27 out of 30 patients,
the first 30 we treated, or 90 percent, had a complete remission after CAR T cells, within a month. A 90 percent complete remission rate
in patients with advanced cancer is unheard of in more than 50 years of cancer research. In fact, companies often declare
success in a cancer trial if 15 percent of the patients
had a complete response rate. A remarkable study appeared in the
“New England Journal of Medicine” in 2013. An international study
has since confirmed those results. And that led to the approval by the FDA for pediatric and young adult
leukemia in August of 2017. So as a first-ever approval
of a cell and gene therapy, CAR T-cell therapy
has also been tested now in adults with refractory lymphoma. This disease afflicts about 20,000
a year in the United States. The results were equally impressive
and have been durable to date. And six months ago, the FDA approved
the therapy of this advanced lymphoma with CAR T cells. So now there are many labs and physicians
and scientists around the world who have tested CAR T cells across many different diseases, and understandably, we’re all thrilled
with the rapid pace of advancement. We’re so grateful to see patients
who were formerly terminal return to healthy lives, as Emily has. We’re thrilled to see long remissions
that may, in fact, be a cure. At the same time, we’re also concerned
about the financial cost. It can cost up to 150,000 dollars
to make the CAR T cells for each patient. And when you add in the cost
of treating CRS and other complications, the cost can reach
one million dollars per patient. We must remember that the cost
of failure, though, is even worse. The current noncurative therapies
for cancer are also expensive and, in addition, the patient dies. So, of course, we’d like to see
research done now to make this more efficient and increase affordability
to all patients. Fortunately, this is a new
and evolving field, and as with many other new
therapies and services, prices will come down as industry learns
to do things more efficiently. When I think about
all the forks in the road that have led to CAR T-cell therapy, there is one thing that strikes me
as very important. We’re reminded that discoveries
of this magnitude don’t happen overnight. CAR T-cell therapies came to us
after a 30-year journey, along a road full of setbacks
and surprises. In all this world of instant gratification and 24/7, on-demand results, scientists require persistence,
vision and patience to rise above all that. They can see that the fork in the road
is not always a dilemma or a detour; sometimes, even though
we may not know it at the time, the fork is the way home. Thank you very much. (Applause)

100 comments on “A “living drug” that could change the way we treat cancer | Carl June

  1. They were curing CANCER in the 1920's Using Frequency. Yes you heard Correctly. Even TED Talks have had people on sharing this info. YET HERE WE ARE STILL FEEDING THE COFFERS OF THOSE TWISTED ENTITIES. People still suffering and dying. Nothing will EVER CHANGE. It's a Business for Profit Society.

  2. 8 years…..17 years!!!!!!!! so what hes sayin is they've beeeeeen doing this. ig this is how they saved magic and anybody else with millions to spend…must be nice

  3. This sounds like a really interesting option for treating cancer. Getting the cost down sounds like the biggest barrier to expanding the types of cancer it treats and making it affordable enough to be used as an earlier treatment than as a last resort.

  4. To everyone involved that has dedicated themselves over the years, thank you so much. Lost my step dad to cancer just before my 21st birthday. But hopefully by time the mother of my child and myself are older, they will have made more progress. Man what a time to be alive.

  5. But as usual everything cost money. You can live longer if you can afford it. At least my kids and future grand kids can affordably benefit from these discoveries.

  6. Just lost my formerly brilliant Nephew-in-law via my fav niece; youngest of my sister's three girls. Jacob had Glioblastoma; a rare brain tumor he named Steve. Jacob lasted 7 and 1/2 years, dying in his sleep at 39. Law school grad at UNH; Pierce Law School; 2009.

  7. So you've cured cancer. That's great BUT what are your pronouns?

    JK .sane people don't care about your pronouns.

  8. And may the fork be with you. Very intriguing news. Now let's get everyone vaccinated with CART. Sounds good to me. What else can we do? Gidder done. Oh, yes, thank you. ??

  9. With the prevalence of the internet, there are still so many people living in their own world of fake news and conspiracies. I guess people are just not as smart as we think we are.

  10. Yeah! I hit the 1k like! Maybe is a message… great talk! loved the lateral thinking in using the tocolizumab for controlling the CRS. So this IL-6 storm seems weird but taking into account the Hasini Effect, IL-6 seems like a last attempt for the tumor cells to spread.

  11. When will the cost come down to help the common person on the street for every body, and will big pharma want their cut?

  12. What makes me sad is that this would be extremely expensive because it's customized. 99.99% of people would be shut off from this.

  13. It was too difficult to watch the whole video. However, I appreciate the decades of hard work and dedication by yourself and your team to develop this incredible technology which I am sure will help a great deal of people more than it already has. For some it is too late, but a still brighter dawn awaits.

  14. My mother died of acute myeloid leukemia in 1977 after lots of traditional treatments as well as experimental treatments at MD Anderson; cutting edge stuff at that time. It didn't work for her or most of her generation, so I'm always filled with guarded hope when I see new strategies and ideas for moving closer to real cures.

  15. Yo who is tasked with nominating people for the Nobel prizes ? This guy and his team deserve at least 3 of those

  16. I ran The Great North Run in 2019 for Cancer Research UK. I hope the money helps save more people’s lives

  17. Great. So, what drug company will take this new treatment and make it so expensive that only rich bastards can afford it?

  18. A cure for cancer will not emerge from industry until they find a cure that they can make money off of. However, THE cure for cancer has long been known to some of us. It is simple and it costs almost nothing. And THAT is why you have not received the cure for cancer from the medical industry. Give me a "click" if you want to know a whole lot more……

  19. Synthetic immune system, HIV-virus, Coma, – what could possibly go wrong, ha ha ha.

    What's wrong with GcMAF, an anticancerous substance our own bodies make, but some people are very low in? Why are you having GcMAF as a treatment, outlawed??? Can't slap a patent on it and sell it for gazillions???

    Scientific papers on GcMAF:

  20. They already have many cures for cancer. Look into Greg Braden's work, best selling author. He demonstrates how they cute cancer in Chinese hospitals, which is displayed on a sonar gram (ultrasound) as the treatment is taking place. Big pharma is the biggest scam of all time!

  21. hmmm i don't trust it…but happy people are ured….what if the patients cant die though, like the chimera is incapable of allowing for necrosis :O ZOMBIESSSS

  22. As much as I wish mankind to find a cure for cancer (and every other incurable disease), I think it won't happen. Not because of scientists' inability but because of governments and world leaders. They won't be wanting or needing people to continue living, we're already 7.5 billion…

  23. This is one of the reasons why I want to shift my focus from disease characterization to biotherapy development. It's heartbreaking to see how much these patients suffer especially when they're so young. I hope I'll get a scholarship to be able to contribute in this type of research.

  24. Peachy …. synthetic immune cells which can detect DNA patterns and kill cells which match. Not long now until this is weaponized to assasinate people by race and we have a real-life version of Wing Commander IV: The Price of Freedom.

  25. With all due respect,
    There seems but one confusion.
    You said that you have used the HIV virus as a carrier of antibody producing genes in T cells.
    What happens to the HIV virus when you have successfully generated a CAR-T cell?
    Please reply.
    And indeed, your hardwork has created a revolutionary impact in the field of medicine.

  26. But CAR T cells won't yet work on other types of cancer as they are not easily accessible as leukemia. Also using retroviruses have a lot of risks involved.
    Anyway hope eventually we will sort out these problems. Love all dedicated scientists. Hope, one day, I get a chance to contribute to humanity during or after my PhD

  27. Gosh, being a Dr. sounds intense. Imagine sending someone into a coma, thinking you had failed completely, lived with the guilt, then poof, he's fine suddenly. Lol. What a rollercoaster, I couldn't handle it.

  28. Does that synthetic immune system destroy the normal immune system? Do they fight each other forever? Or do they eventually learn to live with each other? Really curious about how they react since it starts with a high fever, which I'm guessing means the normal immune system fights it, maybe?

  29. "A living drug that could change the way we treat cancer" ok this may sound really nerdy but like, venom, ultimate spiderman comic universe, living drug, symbiote, cure for cancer? Are you saying you created venom? I kno this drug doesnt have a real sentience, but like… im tripping out. And not only that, genetic modifying advancements in the next few years doesnt make the idea of spiderman very far off. And now we have venom too! Ok ill stop now

  30. as awesome as it is when it's applicable, it's only applicable when the tumor cells all have a specific antigen which (almost) all healthy cells do not. that is rarely the case.

  31. ….You can't treat cancer if you don't change your lifestyle. Eat only raw food (fresh vegetables, seeds, nuts, fruits), avoid meat, milk, canned food, processed food, etch., and cancer will be gone

  32. Bravo?Now take your Frankeinstein nano cells and make them target the oxidated cells, the iron mecanism in cancer cells is the solution to cure all types of cancer.
    And, a self destruction order after the mission would be more than welcome, you know me, I don't trust this sh#it.

  33. This is Earth shattering Technology in the study of the Cure For Cancer!
    Hopefully, His work progresses to include many more types of Cancers,
    And other Ailments!

  34. Does no one realize this is literally the Resident Evil t-virus!!!! Using fungus which has already exhibited parasitic and zombie like symptoms in hosts.

  35. What a joke.
    People in Thialand hardly ever get cancer and it's all due to their diet. When will people understand that cancer is a business and big pharma has NO INTENTIONS of curing you. It's all a big ole conspiracy. Sheeple need to wake up and for God sake, DON'T GET CHEMO! 97% of the time, chemo doesn't work.

  36. Wow. Get that cost down…. A good life is worth fighting for, but not one in debt that burdens everyone else because we are scared of death.

  37. TED TALKS COPYRIGHT STRIKES anti globalist progressive channels and props up nut bag antifa clown world a$$hat America hating racist leftist soc-com-reeeegressives down with TED

  38. Sounds promising. The bit he said at the end about the need to invest in long-term research, instead of just looking for quick ways to get instant gratification and profit, was super important. Scientific breakthroughs take time, and thorough research helps avoid mistakes and negative consequences.

  39. …aaand this is how the Zombie apocalypse begins.

    jokes aside, this is awesome. Thanks for all the work, and passion to finally come with a better solution.

  40. It would’ve helped at the beginning if he didn’t read while talking to the audience, but he helped find a way to cure cancer so I guess he gets special privileges.

  41. only costs $1,000,000 and if you do not have the money its cremation or burial… That's big pharma hard at work. Rich man medicine. What they always fail to mention is how many people could be living if it was priced to actually help people instead of making a few people wealthy.

  42. Ehm cancer researchers did not gave up on using the immune system to fight cancer thats bullshit immunotherapy is the main focus of cancer research right now everywhere

  43. look up nagalase and how it is reduced by gcmaf. gcmaf makes the immune system fully visible to attack cells

  44. I wish that all the researches could establish international team and collaborate instead of many teams working independently, wouldnt that be more efficient?

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