Loyola, despite its size, has the right mix of ingredients to compete. In a metropolis as large as Chicago, there are plenty of patients willing to experiment with cutting-edge treatments. Nishimura’s experienced clinical partner, Dr. Patrick Stiff (MD ‘75)—tall and sober, with swept sandy hair—manages the care of those patients. The sarcastic and goateed Nishimura is an expert at building the actual cells. On top of that, he has access to the McCormick Foundation’s good manufacturing practices (GMP) facility, one of just a handful in Chicago.
The venture is part of a broader and aggressive investment into cancer research on the part of Loyola. The hematology and oncology division that Stiff oversees has more than doubled since he took over as director, in 2003. “If you can, why wouldn’t you try?” Stiff asked about the new work. “Not many places can.”
Finding a better treatment
The approach, though innovative, is fairly straightforward. To start, a patient’s blood is drawn. Then cancer biologists separate out the patient’s T cells, a type of white blood cell that serves as the workhorse of the immune system.
From there, using a disarmed virus, they genetically modify the T cells to produce receptors on their surface called chimeric antigen receptors, or CARs. Those receptors function like magnets, giving T cells the ability to recognize and attach to antigens on tumor cells, eventually killing them. Once engineered, the new CAR-T cells are expanded in the laboratory (into the hundreds of millions) and introduced into the sick body.
“I’ve learned that you can do almost anything if you try hard enough, if you’re persistent enough.”
— Dr. Michael Nishimura
Immunotherapies like this, which enlist and strengthen the patient’s own immune system, are relatively new in the cancer world. (Surgery, chemotherapy, and radiation are more common.) The first CAR T-cell therapy was approved by the Food and Drug Administration (FDA) in 2017; so far, it’s been restricted to tiny clinical trials nationally. Loyola was one of 22 institutions that participated in ZUMA-1, an early and successful pilot study in which CAR-T cells produced by Kite Pharma were infused into patients with large B-cell lymphoma. (Those results were published in the New England Journal of Medicine in December 2017.) And while patient responses in many of those trials have been remarkable, the prohibitive cost and the potential side effects—swelling in the brain, high fevers, memory loss, and seizures, among others—have tempered enthusiasm.
Nishimura and Stiff are confident they can make the treatment safer and more effective. They’ll do so by engineering the cells in the state-of-the-art GMP lab, a sterile room where a particulate air filtration system strips out airborne dust and microbes. One needs special training and protective clothing even to enter. “If I’m going to inject something into you,” Nishimura said, “you want it clean.”