Facing an aggressive cancer, Victoria’s Noel Schacter considered medical assistance in dying, but is instead living cancer-free as part of an immunotherapy clinical trial involving a Victoria lab that is marking its 20th anniversary.
Schacter, 78, credits B.C. Cancer’s Deeley Research Centre in Victoria for giving him the past three years of life, which allowed him to care for his beloved wife of 33 years until her death last month. “Every day I get up I look in the mirror and I’m amazed I’m still here,” said Schacter, a retired sociologist who lives in James Bay.
“I’m just really very thankful for having the opportunity to live longer and enjoy my life,” he said. “I still think MAID is an important part of our options for those people for whom there is no other way out, but I’m thankful that this came along just in time for me.”
B.C. Cancer’s Deeley Research Centre is a pioneer in immunotherapy research that helps patients mount a stronger and targeted immune response to their cancer. It houses about 50 researchers, staff and students.
Founding director Dr. Brad Nelson co-leads B.C. Cancer’s Immunotherapy Program and leads the Conconi Family Immunotherapy Lab in Victoria.
The lab, established in 2016, was the first in Canada to produce Chimeric Antigen Receptor T (CAR-T) cells to treat patients, and Schacter is benefiting from Phase I/II clincal trials launched in 2019 between B.C. Cancer and Ottawa Hospital with the CAR-T cells manufactured in Victoria.
“What people in Victoria might be surprised to learn is that, right here on Vancouver Island, we’re one of only three centres in Canada that makes CAR-T cells of any type, and the only centre in Canada that makes them for this trial,” Nelson said. “They don’t do it in Vancouver or Ottawa. We’re it.”
“We’ve built a reputation over the last 20 years for doing not only excellent science, but also creating state-of-the-art immunotherapies for patients — and it’s all happening right here in Victoria.” It was the community that stepped up to fund the lab and equipment, said William Litchfield, executive director of the B.C. Cancer Foundation, Vancouver Island, “and now we’re seeing the amazing results.”
An otherwise healthy man, Schacter was 61 when diagnosed with non-Hodgkin’s lymphoma in 2006. Chemotherapy kept the disease at bay. “I got 12 years before the cancer relapsed in 2018.”
It returned as a more aggressive and faster growing disease. The next year of chemotherapy side-effects were “pretty much a nightmare.” Still, treatments pushed him into remission until mid-2020. However, when the cancer returned, all treatment options had been exhausted.
“So I was considering medical assistance in dying [MAID] at the time,” said Schacter.
The difficult decision wasn’t how to die but rather when. Schacter’s wife had Alzheimer’s and was in a care home. “I was really flummoxed,” said Schacter. “I didn’t want to leave her behind, but at the same time I knew that I wasn’t going to make it.”
Schacter heard of a promising immunotherapy treatment in Seattle but the price tag was well over $1 million. (Researchers in B.C. are using a semi- automated CAR-T cell manufacturing process in the hopes of creating an affordable treatment solution for Canadians at a fraction — 10 to 15 per cent — of the cost in the U.S.).
Schacter’s oncologist then suggested he apply for the nationwide clinical trial for patients considered incurable with available treatments. Schacter would squeak in under the age cutoff of 75 and pass a battery of tests.
It was explained to Schacter that doctors would draw his blood, which would be delivered to researchers at Victoria’s Deeley Research Centre.
Then in the sterile “clean-room,” called the Conconi Family Immunotherapy Lab, his blood would be combined with various ingredients to extract the T-cells, the Chimeric Antigen Receptors would then be introduced to genetically modify the T-cells to mount an enhanced and targeted response, and then the cells would be left to grow for a few days.
As a final step, the super-charged and tailored T-cells would be intravenously injected back into his body as a form of treatment.
(A lymphocyte is a type of white blood cell in the immune system mainly consisting of two types of cells: T cells, which are regarded as killers of foreign invaders in the body, and B cells, which produce antibodies.)
“After 12 days, the recipe is done, the T-cells are ready, and they are put into an IV bag — about 200 million — which are then shipped to either Vancouver or Ottawa … where they are infused back into that patient’s bloodstream,” said Nelson.
The engineered T-cells circulate through the blood to every corner of the body “hardwired to be able to recognize and destroy the cancer cells” and where a patient might normally have a million T-cells fighting cancer, they would now have hundreds of millions “and numbers matter,” said Nelson.
“If there’s more cancer cells than T-cells, you’re going to lose that battle. In this way, though, we can really tilt things in favour of the T-cells,” he said.
Shacter was in hospital in Vancouver for about five weeks. The side effects — being unable to walk — weren’t insignificant but they “weren’t anything like chemotherapy.”
Soon afterward, a positron emission tomography scan, called a PET scan, showed he was in remission. In October it will be three years.
He calls it a scientific miracle but then reframes it as simply “strong scientific research” and therapies by the Deeley Research Centre.
“They do a fabulous job,” said Schacter. “I’m still on the razor’s edge, in a way, but I know the chances of the cancer coming back are very slim.”
The first B.C patient in Phase I/II of the pan-Canadian clinical trial for leukemia and lymphoma patients in Victoria, Ottawa and Vancouver was treated in 2020.
Results from the first 30 patients have been published. In 13 patients, no cancer was found after treatment, two had a partial response, five saw the disease progress and nine died. Now in Phase II, a total of 70 patients have been treated on the way to 100.
“We’re just getting fabulous results,” Nelson said.
“From there, we’re looking at potentially seeking Health Canada approval to be able to offer this as a standard-of-care product to patients in B.C. and potentially other Canadian provinces,” he said. He estimates if that happens it would be over the next couple of years.
Beyond blood cancers, the Deeley Research Centre is now devising strategies for how CAR-T cells might treat solid tumours, specifically pancreatic cancer and ovarian cancer, among the two most difficult to treat because in part they have tougher defence mechanisms that block T-cells.
Researchers around the world are trying to do this because solid tumours represent the majority of cancers but “nobody’s really cracked that nut,” Nelson said. “We’ve got big plans for all sorts of clinical trials over the next few years.”
Immunotherapy is becoming a second-line treatment on the way to becoming a frontline therapy.
Schacter expresses gratitude that the CAR-T cell program came along just in time for him, giving him precious time and hope.
“If wouldn’t have had this treatment, I’d be dead by now. I mean, there’s no doubt about it, I’d be long gone,” said Schacter.
Schacter never did tell his wife about his cancer journey — “it would have just traumatized her” — and instead he enjoyed the time they were given together. She died on July 18.
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