BiTE immunotherapy offers new hope for patients with aggressive cancers

BiTE immunotherapy offers new hope for patients with aggressive cancers

When Diann Jackson's lymphoma returned after less than a year, she came to the Cancer Center and Research Institute at the University of Mississippi Medical Center for immunotherapy.

Now in remission, Jackson underwent Bi-specific T-cell Engager, or BiTE, therapy to fight diffuse large B-cell lymphoma, a fast-growing blood cancer that affects the lymphatic system. BiTE helped Jackson's immune system fight cancer more effectively.

BiTE is part of a growing area of precision immunotherapy. By targeting specific markers on cancer cells, they aim to improve effectiveness while minimizing damage to healthy tissue.

"BiTE is the next generation of cancer therapies," said Dr. Carter Milner, professor of hematology and oncology. "Unlike CAR T-cell therapy, BiTE therapy doesn't require genetic modification of a patient's cells. Instead, it is an off-the-shelf medication, which makes it more accessible for patients."

T-cells normally patrol the bloodstream looking for abnormal cells, including cancer. However, cancer cells can disguise themselves and avoid detection. The "engager" part of BiTE therapy solves this problem by forcing contact between the T-cell and the cancer cell.

Once connected, the T-cell attacks the cancer cell, releasing immune signaling proteins called cytokines that recruit other immune cells. Those cells release proteins that break through the cancer cell's surface, causing it to self-destruct.

"BiTE therapy can be a bridge to CAR T-cell therapy and possibly bone marrow transplantation if remission is achieved, Milner said. "To undergo a bone marrow transplant, a patient typically must be in remission or have chemotherapy-sensitive disease; however, patients with refractory disease are candidates for CAR-T therapy."

CAR, or Chimeric Antigen Receptor, T-cell therapy involves the genetic modification of a patient's T-cells, helping them identify and attack cancer cells with greater precision. CAR T-cell therapy involves one infusion of a patient's modified T cells, but BiTE is a drug given in a series of injections every few weeks.

Jackson's cancer journey started four years ago with an ache in her lower abdomen.

"I had just had a colonoscopy and thought it might be because of that," she said.

When the pain didn't subside, she underwent imaging and a biopsy and received a diagnosis of diffuse large B cell lymphoma. About nine months after her initial treatment concluded and her first remission, her cancer returned. She was referred to Milner, whose specialty is in malignant hematology, including the management of lymphomas, leukemias and myelomas.

For BiTE injections, Jackson stayed overnight in the UMMC Bone Marrow Transplant and Cellular Therapy Unit for the first few ramp-up doses of her therapy. Once she tolerated the normal dose level, she was able to resume outpatient management in the clinic.

"Some of the doses made me very sick," she said. Side effects for BiTE therapy include an inflammatory response known as cytokine release syndrome and the potential for neurotoxicity, also known as immune effector fell-associated neurotoxicity syndrome, which a care team must be prepared to manage.

Since therapy ended, Jackson said she reached a year cancer-free in February. "So far, no cancer has shown up in my PET scans," she said of the imaging test, which is often used to detect cancer.

"I give the Lord credit," said Jackson, a member of Heritage Family Church in Brookhaven, "and one of the blessings has been having Dr. Milner as my doctor. God does miracles every day."