While looking into the eyes of his dog, Aretha, publicist Paulo Peregrino, 61, considers going out for a walk with her around the condominium where he lives, in Niterói (RJ).
Everyday action represents a breakthrough for him. Less than three months ago, Paulo was hospitalized due to complications from sepsis acquired in the hospital shortly after undergoing an innovative treatment for cancer.
The publicist had been diagnosed in 2010 with prostate cancer and, eight years later, with non-Hodgkin’s lymphoma, undergoing several chemotherapy sessions and even a bone marrow transplant, but without success.
“[Quando descobrimos] my first prostate cancer, the doctor decided not to do anything because the tumor was encapsulated [localizado dentro de uma membrana], without risk of spreading. After a year or two, we saw that there were two more [tumores]. And then when I went to start the treatment, we noticed the metastases in the legs already”, he said.
From then on, there were numerous chemotherapy sessions and dozens of doses of morphine for pain, in addition to the transplant. Due to the tumor, he also developed purpura, an autoimmune disease.
Until he received CAR-T cell therapy at Hospital das Clínicas in São Paulo. Since then, she has had complete remission of the tumor.
“I feel great. Of course I still need to check-up, see my exams periodically, but I don’t feel pain anymore, I’m sleeping well, eating well. I still feel tired and I’ve lost a lot of muscle, but little by little I’m getting back to doing my activities daily, like walking here at home with my dog”, he said.
Paulo was included in a study by the Center for Cellular Therapy, at HC, in partnership with the USP Medical School in Ribeirão Preto and the Butantan Institute. In addition to the advertiser, 12 other patients have already been treated at Nutera (Advanced Therapy Center). “The results are very promising. They are patients with very poor health and an advanced stage of cancer”, said Vanderson Rocha, the physician who is leading the research.
CAR-T uses immune system cells (known as T lymphocytes) taken from the patient and genetically modified to recognize and attack tumor cells.
The therapy has been successful in treating some types of cancer of the blood system, lymphomas and leukemias, but there is no proof of effectiveness against solid tumors. In these cases, chemotherapy, radiotherapy or treatments such as immunotherapy tend to be more effective.
The technique has been authorized by Anvisa (National Health Surveillance Agency) since 2021 for the so-called compassionate use in Brazil. This practice is adopted when there is no other approach possible and therapies still under study are used to try to save the patient’s life.
In addition, the agency approved in July 2022 the first clinical trial for the national development of CAR-T cells for the treatment of cancer at Hospital Israelita Albert Einstein.
The patients included in the study are all SUS (Sistema Único de Saúde) users, and the research received financial support from the Ministry of Health.
“We have the only CAR-T research program in the country, which will also assist cancer patients at Hospital Municipal Vila Santa Catarina. We have developed our own product and hope to receive approval from Anvisa for use soon. [na população]”, said Einstein’s director-superintendent of research, Luiz Vicente Rizzo.
In general, patients with a very aggressive cancer, or who have a weakened immune system, have more difficulty generating their own immune response, which is why CAR-T therapy can be an important ally.
One of them is municipal servant Ana Cleire Marques Diógenes, 61, diagnosed for the first time with non-Hodgkin’s lymphoma in 2017. After treatment with chemotherapy in her hometown of Fortaleza, Ceará, she went through a period of remission until, in 2021, the first relapse came.
Like Paulo, Ana underwent a bone marrow transplant in January 2021. The process is similar to CAR-T therapy, but they are bone marrow cells, while CAR-T therapy uses lymphocytes. Even after the transplant, the server had a new recurrence in 2022.
“That’s when my first doctor suggested that I contact a doctor in São Paulo and I was invited to participate in the study at Einstein. I was hospitalized on March 1st. [de 2023] and on the 11th we already infused the CAR-T cells”, she reported, that 60 days after the treatment she already has total remission of the cancer.
The patients are particular cases of aggressive tumors, which were not effective in conventional treatment, and which could be included in the studies. The PET-Scan image exams (computed tomography) already indicate a remission of the tumor in both cases, but it is still too early to talk about a cure.
This is because remission is when there is no more tumor focus in the body, while cure, according to the international clinical protocol, is when there is no more tumor focus and remission remains five years after therapy.
To date, no patient has been included in the study with follow-up longer than one year and four months. Therefore, there has not been any case of cure yet described.
Even so, Ana and Paulo already breathe a sigh of relief. “It is a very big hope because there are many people doing research daily so that this treatment, which is minimally invasive, reaches more people”, said the server.
Paulo considers that his participation in the study can serve as an example. “To everyone, everyone who took care of me at the hospital, I said you have a fundamental part of my victory. And I hope that in the future others will not have to go through as much difficulty as I did.”