Georg Schett, MD, on Future Goals for CAR-T in Autoimmune Disease

“Imagine you can abrogate the whole disease with a single infusion and do this early and prevent organ damage. I think that concept is very appealing. At the moment, I think we are not there because [earlier on] data on safety were basically not present, but now [those data] are actually coming up more and more. So at the beginning, actually, the therapy was limited to very resistant patients, but I think the concept to move earlier, if safety data look good, which they do so far, is extremely appealing to prevent organ damage.”

Around 3 years ago, chimeric antigen receptor T-cell (CAR-T) therapy was evaluated in patients with autoimmune disease for the first time. Patients with severe disease and few or no other treatment options were enrolled in this study, as little was as of yet known about the efficacy and safety of CAR-T in the context of autoimmune disease. This initial effort utilized autologous CAR-T therapy, which has a somewhat lengthy manufacturing time.

Following the success of this and other early efforts assessing CAR-T in autoimmune disease, some companies and academic institutions are now considering the next steps for the field of cell therapy in autoimmune disease, with an eye for broadening eligibility and optimizing safety, efficacy, and accessibility.

Georg Schett, MD, vice president of research and chair of internal medicine at the University of Erlangen – Nuremberg, who served as an investigator on the earliest CAR-T trial for autoimmune disease, recently spoke with CGTLive® about his perspective on the future of the field. Schett went over the lessons learned from the early studies, noting that a strong safety profile has been seen, with low risks of high grade cytokine release syndrome and neurotoxicity. With regard to potential future innovations, Schett touched on the need to streamline and shorten manufacturing processes and the possibility of utilizing hypoimmunogenic allogeneic CAR T-cells to scale up production and offer an off-the-shelf option.

Schett also noted that if CAR-T in autoimmune disease continues to demonstrate safety, it may eventually be able to be used as an earlier-line treatment in patients with severe autoimmune disease. He emphasized the potential benefits of CAR-T over other options in this scenario.

Relevant disclosures for Schett include Bristol-Myers Squibb, Cabaletta, Janssen, Kyverna Therapeutics, and Novartis.