From clinical trial to clinical tool: Bringing CAR-T to patients

Dr Philip George has been a part of New Zealand’s CAR-T journey from the very beginning, helping establish the ENABLE phase 1 trial, and now helping lead its phase 2 successor. 

Having trained in the United Kingdom, where CAR T-cell therapy is standard of care for certain blood cancer, Phil is determined that New Zealanders gain access to the same life-changing technology here at home. 

Clinical breakthroughs don’t happen overnight; an enormous amount of work takes place behind the scenes. Scientists spend years refining and testing new cancer therapies, carefully building treatments that one day may change a patient’s life. The journey from scientific discovery to treating a patient is rarely rapid.  

Phil has been a part of that journey with CAR T-cell therapy at the Malaghan Institute from the very beginning.  

In 2018, midway through his specialist training in haematology at the University Hospitals of Leicester in the United Kingdom, Phil was looking for an opportunity to gain experience in clinical research. Through a mutual connection he was introduced to Professor Robert Weinkove, Clinical Director at the Malaghan Institute and leader of the CAR T-cell programme.

Phil was soon recruited for a clinical research fellowship at the Malaghan Institute, flying half way around the world to help establish New Zealand’s first CAR-T trial. As well as testing the safety of a newly developed CAR T-cell product for B-cell non-Hodgkin lymphoma, it was the first step in creating local capability to manufacture and deliver CAR T-cell therapy in New Zealand.  

Three years later, with the ENABLE trial well underway, Phil returned home to complete his specialist haematology training. During this time CAR T-cell therapy was becoming increasingly embedded as a standard of care treatment for B-cell non-Hodgkin lymphoma globally.  

Today, eight years after first joining the Malaghan’s CAR-T team, Phil is back in New Zealand as Principal Investigator of ENABLE-2, the phase 2 trial designed to confirm the safety and establish the effectiveness of our CAR T-cell therapy, and ultimately gather the evidence needed to be registered for standard of care delivery in New Zealand. 

In many ways, Phil’s career has unfolded alongside the development of CAR T-cell therapy in New Zealand from helping establish the first safety trial, to now helping lead the study that could bring the treatment into routine clinical practice. 

“It was a great opportunity to work on the ENABLE trial from the early days,” he says. “To go from helping set up the study to now treating patients on the phase 2 trial, you really see how much work it takes before a therapy can move beyond clinical trials and become widely available in the health system.”

Behind every infusion is a coordinated effort by clinicians, nurses, laboratory teams, and collaborators across the country. Much of this happens out of public view: refining protocols, ensuring safety, navigating regulatory pathways. But at the bedside, that collaboration translates into a new possibility for patients.  

“CAR T-cell therapy provides a new modality of treatment, which is very positive for patients and their families,” he says.  

Unlike chemotherapy, which broadly targets rapidly-dividing cells, CAR T-cell therapy involves collecting a patient’s own immune cells, modifying them to better recognise cancer, and returning them to the patient to seek out and destroy cancer cells.  

“I still remember the first patient we treated,” Phil says. “It was an incredible moment.”  

The sense of continuity – from discovery to delivery – is exactly what drew him to specialise in haemotology in the first place.  

“In haematology, we’re often involved right from the beginning; making the diagnosis, performing the bone marrow biopsy, analysing the pathology, sending off tests, and then delivering the treatment. Most specialties don’t have that full journey.”  

For Phil, being part of that journey from diagnosis through to therapy is both a privilege and a responsibility. “You get to know your patients really well because you’re closely involved in their day-to-day care. It’s rewarding but also challenging.  

“In the UK, CAR T-cell therapy is being made readily available to patients who need it,” he says. “In New Zealand, unfortunately we do lag behind a number of other countries when it comes to funding for blood cancers and availability of advanced treatments.

“When we know that there are treatments that could benefit our patients, but we can’t offer them in New Zealand, it’s a very tough situation.”  

The CAR T-cell product being trialled by the Malaghan is not just about closing the gap – it’s about going further. Globally, the main barriers to CAR T-cell therapy are the cost of manufacturing and the burden of managing side effects. By developing local manufacturing capability and refining a CAR T-cell therapy with an improved safety profile, the Malaghan and our partner BioOra are working to reduce costs while lowering the treatment burden on patients and the health system.  

As Principal Investigator of ENABLE-2, which got underway in July 2024, Phil oversees patient recruitment across the country with colleagues from Auckland and Christchurch. He also leads the clinical care of participants throughout the trial, guiding them through the treatment journey while ensuring the therapy is delivered safely, managing any side effects that may occur. What began as a single clinical study has evolved into a coordinated national network, allowing patients to be assessed and treated closer to home. 

“I chose to return to practice in New Zealand because I really get to collaborate with colleagues around the country in a very close-knit way. You really feel like you can make an impact on a national level.”  

The ENABLE-2 clinical trial is a testament to the strength of New Zealand’s haematology network, bringing together clinicians, researchers and treatment centres across the country to assess, refer and care for patients seamlessly. It demonstrates that the coordination and capability required to deliver CAR T-cell therapy nationwide exists. Irrespective of the results of this trial, this study firmly lays the foundations to roll out CAR T-cell therapy effectively nationwide.  

Phil explains that innovation alone is not enough, however. For this treatment to truly change outcomes in New Zealand, access is the final piece that completes the picture.  

“The implications are significant. B-cell malignancies disproportionately affect Māori and Pacific Peoples in Aotearoa. Without equitable access, those most impacted by blood cancers risk being the least able to benefit from this therapy. 

“Ensuring it’s available through the public health system is essential – that’s the big goal.”  

The ENABLE trials are a foundation for New Zealand to continue developing and adapting CAR T-cell therapies, expanding their reach to more blood cancers and potentially other diseases, ensuring that cellular therapies are being used at their full potential. Newer CAR constructs are already in development, with the potential to improve durability and efficacy. Internationally, CAR T-cell therapy is transforming outcomes across a wide range of diseases.  

“At the moment in New Zealand, only patients with aggressive B-cell lymphomas are able to access CAR T-cell therapy on a clinical trial,” Phil says. “But I’d certainly hope myeloma is an area this treatment could be expanded into within New Zealand in the next couple of years.”  

CAR T-cell therapy is more than a treatment; it’s a lifeline for patients across New Zealand, offering hope where there was once none. For Phil, ENABLE-2 is about embedding CAR T-cell therapy into routine practice in New Zealand, and leveraging the technology to target more diseases that affect our loved ones.  

“As clinicians, we need the right tools available when our patients need them,” he says. “CAR T-cell therapy is an important part of that toolkit.”