A little bit nervous and a little bit scared.
Meet Cal Miller
A life-saving CAR T therapy for solid tumors was a dream come true for California teenager Cal Miller and his family. However, it required the bold step of trying something that had not been tried before on pediatric patients.
“I was a little bit nervous and a little bit scared, as this treatment seemed to be pretty new,” says Cal of the CAR T clinical trial that saved his life in July 2020. He was 13 years old and had been suffering since December 2017.
It was a bumpy road to get to the CAR T solution.
“Just before his 11th birthday, Cal complained of headaches, so we took him to the doctor,” says Cal’s mother Caroline Corner. “The eventual diagnosis was Primary CNS lymphoma, which is ultra-rare in children with only a handful of cases around the world.”
The family worked with Taymour Hammoudi, MD, PhD, and Anuradha Banerjee, MD, at the University of California, San Francisco (UCSF) Medical Center to develop a plan to help Cal. They decided upon a six-month chemotherapy protocol that had been successful with children in Europe. Cal responded well and a June 2018 MRI showed a total absence of tumor.
“Unfortunately, a follow-up MRI one month later showed that the tumor had come back,” says Caroline. “Cal went back on chemo, but it just didn’t seem like a long-term solution.”
While the doctors and family kept searching for effective treatment, Cal did his part. He changed schools so that he could benefit from a one-on-one tutoring and a distance learning program, kept engaged with his teachers and showed an affinity for math. He counted on his three brothers and one sister for entertainment, including building Legos and playing video games. His next step medically was an autologous stem cell transplant in December 2018.
“It was arduous, and Cal was very sick following the transplant,” says Caroline. “He seemed to be responding well, however, and while having a year of maintenance chemo, Cal went back to his usual school in February 2019. He was feeling fine.”
Then a March 2020 check-up scan showed a return of the tumor. Cal resumed chemo in April, but this time it wasn’t helping at all. Cal got sicker and sicker, and things became quite dire. It was then that doctors told Cal and his family about a new CAR T-cell therapy. The problem was Cal needed a stable tumor to qualify for the trial.
“Cal was so sick; he had lost his appetite totally and was wobbly and weak. We had to get his tumor under control,” says Caroline. “Radiation sounded horrible, but it was our only hope of preparing Cal for the clinical trial.”
After 12 rounds of whole brain radiation, Cal’s tumor was knocked down enough for him to qualify for the CAR T-cell trial. Anu Agrawal, MD, at UCSF Benioff Children’s Hospital Oakland oversaw Cal’s treatment plan. First, there was some chemo, then the removal of Cal’s cells for laboratory re-engineering and finally the return of the new fighter cells to his body. “The infusion of new cells back into Cal was somewhat of a non-event,” says Caroline. “After all, he’d been going through chemo for years, and at first, this didn’t seem any different.”
But it was different. Very different.
The next couple of days the family anxiously awaited the intense battle expected to take place internally to signal that Cal’s lab-engineered CAR T-cells were attacking and killing the cancer cells. It happened, and Caroline says the doctors and nurses monitored Cal closely and fed him intravenously so he could stay strong to allow the CAR T-cells to do their important work.
“Just one week later, a scan showed the tumor was completely gone,” says Caroline. “We were just hoping that scan would show the tumor hadn’t grown anymore, so we were completely shocked.”
Cal says “I was so happy. I was astonished at how amazing this treatment was and how fast it worked. We were all very happy.”
These days Cal wants to help other kids and families understand that “they’re in good hands with this new immunotherapy. CAR T is the top-of-the-line treatment. It’s new now, but it will be the normal regimen in a couple of years.”
Who knows? Maybe someday Cal himself will offer this treatment to another teenager when he fulfills his dream of becoming a doctor.