‘Victory of faith, science and people’s positive energy’, says patient after complete remission of cancer

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Paulo Peregrino underwent therapy that fights the disease with the patient’s own defense cells modified in the laboratory and is being studied for three types of cancer: B lymphoblastic leukemia, B cell non-Hodgkin’s lymphoma and multiple myeloma. Doctor Vanderson Rocha (left) and Paulo Peregrino (right) Personal archive Paulo Peregrino had been fighting cancer for 13 years and was about to receive palliative care when, in April, he underwent a treatment considered revolutionary in the fight against the disease and, in just one month, he had complete remission of his lymphoma. So far, 14 patients have been treated with CAR-T Cell, the therapy that fights the disease with the patient’s own defense cells modified in the laboratory. The study uses funds from the State of São Paulo Research Foundation (Fapesp) and the National Council for Scientific and Technological Development (CNPq). All treated patients had remission of at least 60% of the tumors. The recovery was in the Unified Health System (SUS). The method targets three types of cancer: B-lymphoblastic leukemia, B-cell non-Hodgkin’s lymphoma, and multiple myeloma, which affects the bone marrow. Treatment against multiple myeloma is not yet available in the country. Scans show before and after patient cancer; on the right, image showing remission of the disease Personal archive The 61-year-old publicist is the most recent case of complete remission in a short period of time in the study group with 14 patients from the Cell Therapy Center. The protocol was adopted by the University of São Paulo (USP), in partnership with the Butantan Institute and the Blood Center of Ribeirão Preto. Paulo was discharged on Sunday (28) after being under medical care at the Hospital das Clínicas in the city of São Paulo. “The victory is not mine alone. It’s from faith, science and people’s positive energy. Each of them helped to put a parallelepiped on this path. The image very clearly proves to anyone the severity of my lymphoma, and I had no idea it was like that.” On Monday (29), he said, on his Instagram profile, that, with the repercussion of his story in the media, “I’m sure that at least I will have, modestly, given hope to those who need it so much”. “I just want the information and knowledge gained from my case to be of use to other patients in the future.” Vanderson Rocha, professor of hematology, blood therapy and cell therapy at the USP Medical School and national coordinator of cell therapy for the D’Or network, is in charge of Paulo’s case. “It was a very quick response and with so much tumor. I get emotional [ao ver as duas ressonâncias de Paulo]. I was very surprised to see the answer, because we have to wait at least a month after the cell infusion. When we saw it, everyone cheered. I put him in the group of tenured professors at USP and everyone was impressed to see the response he got”, celebrated the specialist. Among the other 13 patients treated like Paulo, 69% had complete remission within 30 days. The first patient treated with the technique in the public health system in Brazil had results similar to those of Paulo, but died from a domestic accident at home. Before and after The two Pet Scan images (CT performed with a special contrast ) (see above) represent “two Paulos”: the one on the left, the patient whose only path was palliative care, when the alternative is to provide comfort, but with no expectation of cure, and the one on the right, a patient with an organism already without tumors after treatment with CAR-T Cell. Car-T Cell: understand cell therapy against cancer applied experimentally Currently, the procedure at the Cell Therapy Center is done in a compassionate way, when the study accepts the patient in an advanced stage of the disease, and the doctors obtain authorization from Anvisa for the application of the method. When the doctor had contact with Paulo, the publicist had already undergone surgical procedures, dozens of tests and chemotherapy. Find out what cell therapy against cancer is applied in a study in the public network Cost of R$ 2 million per patient The technique is used in a few countries. In Brazil, in the second semester, 75 patients should be treated with CAR-T Cell with public funds after Anvisa authorization for the clinical study. Currently, the treatment only exists in the Brazilian private network, at a cost of at least R$ 2 million per person. “Due to the high cost, this treatment is not accessible in most countries of the world. Brazil, on the other hand, is in a privileged position and has the rare opportunity to introduce this treatment in the SUS in a short period of time” , says Dimas Covas, coordinator of the CEPID-USP Cell Therapy Center and the Cell Therapy Center of the Blood Center of Ribeirão Preto, which developed the Brazilian version of this technology. Doctor and patient undergoing treatment in São Paulo Personal archive 13 years ‘moving forward’ timeline-cancer A timeline helps guide the comings and goings of Paulo’s tumors. The trajectory will be told in an autobiography still in production entitled “A Vida pelo Copo D’água”, in which he mentions his medicine: “faith and science to live the full half of life”. The advertiser lives with his wife and son, aged 29, in Niterói, Rio de Janeiro. The family is from Recife, but moved to the Southeast in the 70s. He is the youngest among 10 brothers. He was the first to face the disease. Patient with cancer for 13 years has complete remission in SP in a month after cell therapy in a public health study In 2018, when he started treating his first lymphoma, his days were divided between work, chemotherapy and beach volleyball matches . He even played a championship in the Rio de Janeiro sands. “The doctor told me that I was the first patient who did a high-performance sport while undergoing chemotherapy. I said: ‘The sport is high performance, but my volleyball is not’”, he joked. Patient even participated in beach volleyball championship Personal archive Book in bed and temporary blindness In 2020, the Covid pandemic isolated Paulo in a hospital room. He had undergone a bone marrow transplant. Without escorts, alone, however, he did not stay. He asked the nurse for the contacts of patients in neighboring rooms and created a WhatsApp group called “BMT Together” (a pun on “bone marrow transplant” with TMJ for “we’re together”). The group was formed by him, an elderly man with his wife and a 17-year-old teenager, who shared stories, motivated each other and exchanged songs during isolation WhatsApp group for patients Archive Within 30 days, Paulo pre-released “Brizola e eu”, a book “banhado ” to alcohol and autographs. The scheme was: the wife handed the copies to the nurse, alcohol sanitized the books, he signed, and the copies were taken to friends and relatives. The book tells the biography of Jecy Sarmento, one of the main advisors and friends of former governor Leonel Brizola. The end of that hospital cycle was marked by a cake taken as a surprise by the nurses. Contamination by Covid came in 2022, during a hospital stay due to a drop in platelets — the lower their count, the higher risk of heavy bleeding. The severe cough caused internal bleeding in both eyes and temporary blindness for three months. “It was the worst feeling of my life. I went to three doctors and only the third said: ‘We’re going to operate and remove that hemorrhage from your eye.’ Treatment change Hospitalization for a bone marrow transplant in 2020 Personal archive Searches on the internet led the family to the CAR-T Cell treatment and to the doctor Vanderson Rocha. “I started accompanying him when I had already done a large part of the treatment. The disease returned, so his last option really was CAR-T Cell. I had to ask for authorization from Anvisa so that we could carry out this type of treatment. Many patients do not have this opportunity”, explained the specialist. Paulo remembers that he had a fever on the first day the modified cells were applied to the body, and he even went to the ICU to be monitored. “I felt a little numbness in my hands, but I was monitored before, during and after by the entire multidisciplinary team at HC, in São Paulo.” Despite the remission of the disease in a month, between March and April of this year, Paulo left the “healing festival” for November. For the time being, he will stay in São Paulo for follow-up. “We only have two ways of thanking life: being resilient, which drove me to get here, and doing good for people”, he says. Paulo with his wife, Ana Maria, and their only son, Gabriel Personal archive ‘Object of study’ The physical educator Bruno Marques Giovanni is another of the patients in the study group that Paulo participates in. A year and a half ago, the physical educator resumed the routine, after leaving the Hospital das Clínicas in Ribeirão Preto. It was three years of fighting an aggressive leukemia, which insisted on returning. Only after five years of the disappearance of the tumors can they and the other cancer patients be considered cured. there, Bruno returns to the hospital every three months to undergo tests. “Because it is an innovative treatment, a business that is still being studied, in evolution, I go there with the greatest pleasure to undergo these tests, so that they can see everything what’s going on. Because I know I’m an object of study, in quotes, but a person who is super well. I just thank the whole team always.” CAR-T Cell in the SUS The production of these cells is complex and has a high cost, around R$ 2 million per patient, not counting hospitalization costs, according to Dimas Covas. the national version of this technology, and, in 2019, the first successful treatment was carried out. Only Brazil uses the technique throughout Latin America. In 2021, the group entered into a partnership with the Butantan Institute and two factories were installed in the state, one in Cidade Universitária, in São Paulo, and another on the university campus in Ribeirão Preto with an initial production capacity of 300 treatments per year. with lymphoma and leukemia and generate the clinical data that allow the registration of the product at Anvisa”, explained Dimas. “This clinical study will cost BRL 60 million, but it will save BRL 140 million in relation to the prices charged by private companies. We recently presented the project to the Ministry of Health and the expectation is support and funding to advance this important technology in the country, which could start a new biotechnology industry”, he added. The forecast is that the study will begin in August this year. “There is already a queue of patients, because the doctors who already know that we are in this process are constantly sending names of people, and these names are being placed in a queue due to requirements.” What Anvisa says The Agency told g1 that it has given priority to the analysis of the study. “Anvisa received a clinical trial proposal conducted by CEPID-FAPESP-USP and this request is under analysis by Anvisa. The request is part of a pilot project in which Anvisa selected the Cell Therapy Center (CEPID-FAPESP-USP) in Ribeirão Preto for collaboration in the development of advanced therapy products in Brazil. Thus, the Agency has been in dialogue with the CEPID-FAPESP-USP development team to improve the study design. CEPID-FAPESP-USP has also established a schedule with Anvisa to send information about the possible manufacture of the product and the applicable controls in the coming months. Anvisa, in turn, has given priority to these analyses, providing quick feedback to the developer, with the objective of prioritizing the execution of this study in Brazil.” How the technique works The production of the therapy begins with the collection of defense lymphocytes of the patient’s T-type, which are like “soldiers” of the immune system, and which are taken to the laboratory and genetically modified. These cells are genetically modified to recognize the cancer, they are multiplied in millions and returned to the patient, where they circulate, find and kill the tumor without affecting normal cells. The patient’s own cells are “trained” to fight the cancer scrolly T cell

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