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Friso Calkoen 'Immunotherapy CAR-T: from newcomer to treatment of the future'

'It's great that nowadays we can change a child's own cells in the laboratory into super cells that attack the cancer cells in a very targeted way. We're now looking at what else is possible to use this method better and for other forms of childhood cancer,' says dr. Friso Calkoen, a pediatric oncologist who has been working at the Princess Máxima Center for Pediatric Oncology since 2018 and specializes in this form of immunotherapy. CAR-T is a cell therapy that is given as a treatment to children with acute lymphoblastic leukemia (ALL) in which the B cells are affected and in whom chemotherapy does not work. 'As a next step, we are investigating how CAR-T can be used intelligently and whether it is also a treatment for children with solid or brain tumors. By doing so, we hope that in the future a larger group of children will benefit from this targeted treatment.'

Every year, 110 children are diagnosed with B-cell acute lymphoblastic leukemia (ALL). This is nearly 20% of children with childhood cancer. The standard treatment for this type of cancer is chemotherapy. For about 10 children a year in whom chemotherapy does not work, CAR-T treatment is an option for some.

The strength and positivity of a child as a source of inspiration

Friso Calkoen: 'The immune system has always fascinated me. During my medical studies and PhD research, both in Leiden, I focused on this subject. I found the strength and positivity of the children enormously inspiring and it made me want to continue specializing in pediatrics. In the Máxima Center, with my research and the treatments with CAR-T therapy, everything comes together. With a lot of passion and a smile, I contribute to our mission to cure every child with cancer with an optimal quality of life.'

From newcomer to treatment of the future

In 2019, the first child in the Máxima Center received this treatment. Since then, 32 children have received it and this form of immunotherapy has grown from 'newcomer' to treatment of the future. The Máxima Center is therefore building its own cell therapy facility in the coming period, so that this new treatment will become available to children more quickly than is currently the case. In addition, the research will be accelerated because the research cells required for this will be made on site.

'The first child to receive CAR-T treatment 10 years ago in the United States is still cancer-free. In addition, the CAR T-cells are still present in her body, which gives protection should the leukemia cells come back. In all these intervening years we, doctors and researchers worldwide, have learned a lot. The possible side effects and complications are well understood and more importantly we know how to control them. The next step we want to take is toward smarter and broader use of CAR-T. '

New perspectives

'Not every child benefits from CAR-T treatment. Together with my colleagues, we are investigating whether a common denominator can be found in children in whom the therapy does work. For example, researcher Linde Dekker has shown that the dose of the drug fludarabine must be optimal to create sufficient space in the blood for the CAR T-cells administered via the infusion. If that space is there, the CAR T-cells can grow better and do their job properly. The next step is to prove this in a large international clinical study that we are currently preparing.

We are also investigating whether CAR-T can be used in the future to treat solid and brain tumors. A large international study, in which the Máxima Center is actively participating, is examining whether CAR-T therapy can also be given earlier in the ALL treatment. In these children, we are looking at whether we can prevent stem cell transplantation by giving them CAR T-cell therapy. As far as we know now, CAR-T has less severe long-term side effects than heavy chemotherapy, so it is important that we investigate this further in the coming years. Looking at how CAR-T has proven itself over the past 10 years and the large group of researchers focusing on this topic, I am convinced that more is possible!

Want to know more about CAR-T?

Watch Friso Calkoen's presentation during the Science Evening Immunotherapy (in Dutch).

The month of June is all about new perspectives at the Máxima Center. This means that we will tell you all about the developments in our research hospital in the coming weeks. In the Máxima Center, care providers and researchers work closely together to constantly improve treatments. Our mission: to cure every child with cancer, with the best possible quality of life.