By Laura Eggertson

Charles Jesso was 57 years old when Dr. Mahmoud Elsawy called him into his office on January 6, 2022.

“The chemo isn’t working,” Dr. Elsawy told Mr. Jesso.

Mr. Jesso had just completed his second round of chemotherapy. The year before, he had been diagnosed with non-Hodgkins’ lymphoma, the fifth most-common blood-based cancer in Canada.

If the powerful cancer-fighting drugs hadn’t stopped the cancer’s progression, Mr. Jesso knew he was out of conventional options.

“Basically, I had six to eight months to live,” Mr. Jesso says.

Then Dr. Elsawy offered a potential lifeline.

He wanted Mr. Jesso to try a new kind of cancer treatment, called chimeric antigen receptor T- (CAR-T) cell therapy. The process involves genetically re-engineering a patient’s T cells, programming these immune cells to recognize and destroy cancerous cells.

This new type of immunotherapy had been around to treat certain types of lymphoma and leukemia for less than five years, after conventional chemotherapy had failed. But only select cancer centres in the United States and in Ontario and British Columbia offered the treatment.

In about half the patients, CAR-T cell therapy put their cancer into complete remission: a breakthrough, considering the deadly nature of the cancers.

“When this treatment came along, it was a game-changer,” says Dr. Elsawy. “It was revolutionary in changing the natural history of this disease. We have people who were destined to die within six months … and are now living for many years, cancer-free.”

Dr. Elsawy, a specialist in blood diseases and cell therapies, had seen the therapy’s effectiveness firsthand during his training in the United States and Canada. He brought the first CAR-T cell clinical trial to Nova Scotia, which became the basis of the program he now leads in Halifax.

Through his own research projects, Dr. Elsawy studies the quality of life of CAR-T therapy recipients, as well as the therapy outcome for patients who have prior lung, liver or kidney disease in addition to cancer.

Dr. Elsawy thought Mr. Jesso was a good candidate for the therapy – but the Nova Scotia program was not yet quite ready to roll.

Mr. Jesso could go to Boston for CAR-T cell therapy, Dr. Elsawy told him. Or, if Nova Scotia Health gave the program the go-ahead, he could become the first person to have the therapy here in Nova Scotia.

Best chance

There were no guarantees CAR-T would work, Dr. Elsawy told Mr. Jesso. But it was his best shot.

Mr. Jesso agreed to try the CAR-T cell therapy. He decided to hold out until the program could start in Halifax.

“The bottom line is – was there an alternative? You’re willing to do anything if you’re given two options, and one is that you die,” Mr. Jesso says.

Mr. Jesso began one additional short course of chemotherapy to prepare his body for the re-engineered T-cells. Then - just as he was approved to go to Boston – Nova Scotia Health agreed the Nova Scotia program was ready to start. That meant he could stay close to his family while he had the therapy.

On April 4, 2022, Mr. Jesso received an infusion of his own T-cells. They had been re-engineered at a pharmaceutical facility in California and then sent back to the Queen Elizabeth II Health Centre. Nova Scotia did not have the capacity to conduct the genetic engineering itself.

The procedure itself was simple. Mr. Jesso received his own reprogrammed cells, injected into his bloodstream through a port in his chest, similar to a blood transfusion. Five minutes after it started, the treatment was finished.

“You don’t feel anything,” he says.

For the next three weeks, Mr. Jesso stayed in hospital, cared for by a team specially trained to watch and mitigate reactions. On two occasions, Mr. Jesso suffered serious but largely reversible side-effects that sent him to the intensive care unit, the first episode just eight hours after the infusion.

Unlike chemotherapy, however, the CAR-T therapy did not make Mr. Jesso feel nauseous or sick, and he had no pain.

Cancer-free

Over the next few months, imaging scans showed the cancer vanishing from Mr. Jesso’s body. In November 2022, he walked his daughter Angela down the aisle. And in December, eight months after the treatment, he returned to work full-time.

“I’m feeling fantastic,” Mr. Jesso says.

Two years later, Jesso is cancer-free. He takes no medications and is not expected to need any further treatments, since CAR-T is designed to be a “one and done” therapy.

“It’s definitely a new beginning,” Mr. Jesso says. “It’s the Phoenix, always rising from the ashes, because when you’re told you only have a couple of months to live, and you get a procedure and you live – that’s a rebirth.”

Since Mr. Jesso received his treatment, Dr. Elsawy and his team have treated 24 other patients with lymphoma that wasn’t responding to chemotherapy with CAR-T cell therapy. The therapy has put more than half – 57 percent – of those patients into complete remission, Dr. Elsawy says.

Living drug

“This is a living drug, meaning that with only a single infusion, the cells continue to proliferate, persist inside the body, and fight cancer,” Dr. Elsawy says. “That leads to responses deepening over time until they cancer is fully eradicated.” .

In total, 80 percent of the CAR-T patients Dr, Elsawy has treated were alive at their last follow-up appointment. By contrast, fewer than 20 percent would likely have survived as long following conventional chemotherapy, he says.

Mr. Jesso believes his life-saving experience emphasizes the critical importance of research, often supported by donors who might one day need similar treatment themselves.

“You will never know when you’re going to need help,” he says.

He couldn’t be more grateful for the care he received from Dr. Elsawy and his team, and he can’t wait to make his next milestone: holding the new baby his daughter is expecting in September.

“Bottom-line is – you’re speaking to someone who was supposed to be dead,” Mr. Jesso says. “It’s a miracle procedure.”

CAR-T therapy is just the beginning of a revolutionary field of personalized, cell-based therapies to treat cancer. The therapy is also promising for other conditions, including auto-immune diseases.

The U.S. Food and Drug Administration has just approved another type of immune cell therapy, called tumor-infiltrating lymphocytes therapy (TIL), to treat melanoma.

Dr. Elsawy hopes to see TIL therapy available to Nova Scotians soon.

He and his team are currently building a CAR-T manufacturing facility where they will be able to re-engineer T-cells in Nova Scotia, rather than sending them to the United States. Having an in-house lab will enable them to deliver the therapy to patients faster, saving them valuable weeks, and more affordably.

Together, the new facility and new cell-based therapies offer real hope to cancer patients like Mr. Jesso.

“CAR-T therapy is a lifeline for certain blood cancers,” Dr. Elsawy says. “It’s just a matter of time before these cell-based therapies go everywhere, beyond cancer treatment.”