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CAR-T cell therapy in India

Released Date : 2024-02-09

CAR-T cell therapy in India



This is for informational purposes only. This information does not constitute medical advice or diagnosis. 

What is CD19 CAR T-Cell therapy? What is unique about it?

  • CAR-T cell therapy is a type of cancer immunotherapy treatment that involves genetically modifying a patient's T cells in a lab to recognize and fight against cancers cells in their body.
  • CAR-T cell therapy has shown remarkable success in treating certain types of blood cancers, particularly acute lymphoblastic leukemia (ALL) and certain types of non-Hodgkin lymphoma(High Grade B Cell Lymphoma & B cell Acute Lymphoblastic Leukemia).
  • CAR-T has given new hope to the  patients who haven't responded to traditional treatments like chemotherapy or radiation therapy. However, The Researchers are continuing to study and refine CAR T cell therapy to make it safer and more effective, and to expand its use to other types of cancer.

How Does CAR-T cell therapy works ?

CAR-T cell therapy how it works

  1. Collection of T Cells: The process begins by extracting T cells, a type of white blood cell, from the patient's bloodstream through a process called leukapheresis.

  2. Genetic Modification: The T cells are then genetically modified in a laboratory to produce chimeric antigen receptors (CARs) on their surface. These CARs are synthetic receptors that can recognize specific proteins found on cancer cells.

  3. Cell Expansion: The modified T cells are grown in large numbers in the lab, resulting in a significant population of CAR T cells.

  4. Infusion: Once a sufficient number of CAR T cells have been produced, they are infused back into the patient's bloodstream. The CAR T cells circulate throughout the body and target cancer cells that express the corresponding protein recognized by the CAR.

  5. Targeting Cancer Cells: When the CAR T cells encounter cancer cells expressing the target protein, they bind to them and initiate an immune response, leading to the destruction of the cancer cells.

  6. Monitoring and Follow-up: Patients are closely monitored for potential side effects and response to treatment after CAR T cell infusion.

What is the name of the drugs use  B-cell cancers (lymphomas and lymphoblastic leukemias). 

  • NexCAR19 is a prescription drug for treating specific B-cell cancers (lymphomas and lymphoblastic leukemias) when other one or more other treatments have been unsuccessful. NexCAR19 is a CAR-T Cell Therapy. It involves your white blood cells by genetically modifying them outside your body, with the tools to identify and destroy your cancer cells

Who is the right candidate for CAR T-Cell Therapy?

  • CAR-T cell therapy is very successful for patients with lymphoma (B cell lymphomas like Diffuse large B cell Lymphoma, Mantle cell lymphoma, Follicular lymphoma), Leukemias (children and adults with B cell Acute lymphoblastic leukemia ), and multiply relapsed/refractorymultiple myeloma.

What is the efficacy and safety of the procedure? How good are the outcomes?

The response rates to CAR T cell therapy are more than 90 % in relapsed/refractory B cell Acute Lymphoblastic Leukemia , and long term cure rate is about 60 %. With conventional treatment the cures are achieved in  B cell ALL only in about 30 % or less patients. Some newer drugs like Blinatumumab are not available in India and are very expensive although these can provide better  outcomes in relapsed disease.

For relapsed  High grade B cell Lymphoma (DLBCL, Mantle cell Lymphoma ,  High grade Relapsed Follicular Lymphoma ) response rate are 70-80 %, while long term cure happens in about 40 % .

Durable remissions are possible in refractory Multiple Myeloma for about 80 % patients with  BCMA CAR T-cell therapy

The risk of mortality and toxicity is generally lower in CAR T-cell therapy,  than allogenic BMT . Major side effects are Cytokine release storm (CRS), which happens in most after infusion but is generally mild. Drugs like Tocilizumab are used  to manage moderate to severe CRS. Neurological toxicity ( ICANS ) can happen in some patients , and severe ICANS is managed with steroids. In the long term, B cell aplasia and lowered immunity happens when IVIG replacement may be required . Care and follow up for infections is continued for many months beyond the infusion.  Response rates are assessed at 1,3 and 6 months generally.

There are some patients where the lymphocytes are not adequate in quantity and quality ( due to effects of previous treatment ) and CAR T-cell manufacture may not be successful in this situation.

At present CAR T-cell therapy is used in B cell ALL , more as a bridge to Allogenic BMT and not as a substitute, except in patients who are not eligible for intensive treatment where it can be used as a definitive treatment.

Is CAR T-cell therapy available in India?


The commercial use of this therapy was approved by the Central Drugs Standard Control Organisation (CDSCO) in October 2023. Currently, NexCAR19 is available in over 30 hospitals in more than 10 cities in India.

What is the difference between chemotherapy and CAR T-cell therapy ?

    • Chemotherapy and CAR T-cell therapy are completely different ways of treating cancer . While chemotherapy has broad mechanism of action and has plenty of off-target adverse effects , CAR T-cell therapy is On-target with lower off-target toxicity , though CAR T-cell therapy does involve use of lower doses of conditioning chemotherapy. CAR T-cell therapy is not a surgery but is a complex , staged medical procedure.
    • Chemotherapy generally cannot cure refractory B cell lymphoma or B cell ALL, while CAR T- cell therapy, in suitable High grade B-cell Lymphoma patients can provide a response rate of 70 % and long term cure rate of about 40 %. In Relapsed /refractory B cell ALL response rates are 90 % and long term cure rate is about 60 % for CAR T cell therapy.

What is the status of this therapy in India currently? Is it commonly available as an option for cancer patients? What does the future look like?

Presently CAR T-cell therapy is not commonly available for patients in India , and very few centres have access and expertise to deliver CAR T-cell therapy.

CAR T-cell therapy is indicated in specific situations, and its role in a particular blood cancer should be discussed with your treating oncologist.  In the US, one has to spend crores of rupees to access CAR T cells, but with herculean efforts at IIT Mumbai and ACTREC (TMH), Mumbai, the indigenous CAR T cells at 1/10th the cost are now close to reality. These cells are presently undergoing phase 2 studies after a successful  phase 1 study.

Another effort is going on at NH Bangalore in collaboration with Immuneel therapeutics where a phase 2 study has been recently completed successfully.

The CAR T -cell tested at ACTREC is fully humanized and seems to cause less adverse effects as compared to the murine origin CAR T-cells presently being used commercially in the US ( Kymriah and Yescarta).

 

Is the CAR-T cell therapy commercially use & approved in India ?

  • ImmunoACT gets CDSCO approval for India's first CAR-T cell therapy for blood cancer CDSCO approved its commercial use in October 2023.

What is the difference between chemotherapy and CAR T-cell therapy?

Chemotherapy and CAR T-cell therapy are completely different ways of treating cancer . While chemotherapy has broad mechanism of action and has plenty of off-target adverse effects , CAR T-cell therapy is On-target with lower off-target toxicity , though CAR T-cell therapy does involve use of lower doses of conditioning chemotherapy. CAR T-cell therapy is not a surgery but is a complex , staged medical procedure.

Chemotherapy generally cannot cure refractory B cell lymphoma or B cell ALL, while CAR T- cell therapy, in suitable High grade B-cell Lymphoma patients can provide a response rate of 70 % and long term cure rate of about 40 %. In Relapsed /refractory B cell ALL response rates are 90 % and long term cure rate is about 60 % for CAR T cell therapy.

Research & Publication CAR-T cell therapy in India

India's first patient to undergo indigenous cancer treatment using 'CAR-T cell therapy', a form of immunotherapy that genetically modifies a patient's white blood cells to combat cancer cells, has been declared cancer-free. The patient, Dr. (Colonel) VK Gupta, a Delhi-based gastroenterologist, took this therapy by paying just INR 4.2 Million which would've otherwise cost him INR 40 Million abroad.

press release

  1. https://sputniknews.in/20240209/indias-indigenous-cancer-treatment-car-t-cell-therapy-cures-its-first-patient-6501400.html
  2. https://www.wionews.com/india-news/india-first-commercial-patient-declared-cancer-free-using-indigenous-car-t-cell-therapy-687858
  3. https://www.timesnownews.com/health/indias-first-patient-dr-v-k-gupta-free-of-cancer-using-indigenous-car-t-cell-therapy-article-107551325
  4. https://www.indiatoday.in/science/story/indias-car-t-cell-therapy-nexcar19-how-it-fights-and-wins-against-cancer-2499708-2024-02-09
  5. https://www.ndtv.com/india-news/indigenous-car-t-therapy-cures-patient-of-cancer-all-you-need-to-know-5023888

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