CAR T-Cell Therapy: The Future of Immunotherapy

CAR T-cell therapy has revolutionised the treatment of blood cancers like leukaemia and lymphoma. T-cells are the body’s natural defenders, targeting and attacking foreign invaders. However, during cancer, the immune system is weakened, leaving the body vulnerable. Chimeric antigen receptor (CAR) T-cell therapy enhances T-cells by modifying them in the lab to better recognize and bind to cancer cells, enabling them to attack and destroy these cells effectively. These specially engineered T-cells are then introduced into the patient’s body to boost the immune response against cancer.

India made its first homegrown CAR T-cell therapy in 2023 to fight leukaemia and lymphoma. The Central Drugs Standard Control Organisation made NEXCAR19 a CAR T-cell therapy. The dream was led by Dr. Alka Dwivedi and team, who went to the USA and learned about the technique, came back to revolutionise healthcare!

Cancer accounts for the most deaths in India. An average cost of cancer treatment can go beyond the income of a middle class family. In healthcare we say that if it’s not affordable then it’s not a solution. Dr. Dwivedi made the solution available to all, especially lower-income groups of the country.

Evolution of Cancer treatment 

Records of cancer are challenging to trace, but one of the earliest documented cases dates back to 520 BC, when a queen was diagnosed with breast cancer. After undergoing a certain treatment and recovering, her improved health played a role in the subsequent invasion of Greece.

Treatment of cancer is critically tough because it is rarely an infection which can be eradicated. Most cancers are an interplay of complex genetics and environmental factors. The rise of cases dates back to the mid 19th century where radical treatment choices were made or in most cases it led to death.

 The evolution of cancer cell therapy has marked a transformative shift in oncology, offering new hope to patients with otherwise intractable cancers. It began with the development of bone marrow and stem cell transplants, which aimed to restore healthy blood cells after chemotherapy or radiation. Over time, the focus shifted toward more targeted approaches, such as monoclonal antibodies that specifically attack cancer cells while sparing healthy tissue. This paved the way for more sophisticated immunotherapies like checkpoint inhibitors, which unleash the body’s immune system to recognize and destroy cancer cells. Here is a list of various treatment options. 

• Bone marrow and stem cell : Critical procedures in the treatment of various blood-related cancers, such as leukaemia, lymphoma, and multiple myeloma, as well as some non-cancerous conditions like severe aplastic anaemia. These transplants work by replacing damaged or diseased bone marrow with healthy stem cells, which can regenerate and produce new, healthy blood cells.

• Radiation : It uses high-energy rays or particles, such as X-rays, gamma rays, or protons, to target and destroy cancer cells. The primary goal of radiation therapy is to damage the DNA within cancer cells, preventing them from growing, dividing, and spreading. 

• Chemotherapy : It is a cornerstone of cancer treatment that involves the use of powerful drugs to kill rapidly dividing cancer cells throughout the body. Unlike localized treatments such as surgery or radiation therapy, chemotherapy is systemic, meaning it travels through the bloodstream and can target cancer cells that may have spread to other parts of the body. 

• Immunotherapy : It is the most advanced therapy that targets the immune system of the body. Unlike traditional treatments like chemotherapy and radiation, which directly attack cancer cells, it works by boosting the natural defences of the immune system or modifying its behaviour to more effectively combat cancer. 

• Customised treatment : For example, tyrosine kinase inhibitors (TKIs) like imatinib (Gleevec) target specific proteins that are overactive in certain cancers, such as chronic myeloid leukaemia (CML). Similarly, HER2 inhibitors like trastuzumab (Herceptin) are used to treat breast cancer that over-expresses the HER2 protein.

Immunotherapy 

Renier J. Brentjens in New York, another leader in CAR T-cell therapy named the therapy as a living drug. T-cells are taken from cancer diagnosed patients, engineered and reframed with special protein to fight cancer cells. Over the years the treatment of cancer has been involved with the primary goal of better survival rate. Earlier the cancer treatment was centred on radiotherapy, chemotherapy and surgery. Over the years oncologists and researchers have shown great interest in immunotherapy. 

It builds your own immune system to fight against the cancer cells. Your immune system often gets weak due to the presence of cancer. Immunotherapy strengthens your own T-cells to combat cancer. Over the years various immunotherapies have been developed. Take a brief look at the new treatment options for cancer. 

T-cell transfer therapy is a form of cancer treatment that enhances the natural ability of your T cells to combat cancer. In this approach, immune cells are extracted from your tumour, and the ones most effective at targeting your cancer are selected or genetically modified in a laboratory to improve their cancer-fighting capabilities. CAR T -cell therapy is based on transfer of T-cell.  

Monoclonal antibodies are lab-engineered proteins that mimic the immune system and are designed to bind to specific targets on cancer cells. By attaching to these targets, some monoclonal antibodies help the immune system recognize and destroy the cancer cells more effectively. 

Immune system modulators are treatments that boost the body’s immune response to fight cancer. Some of these modulators specifically target certain components of the immune system, while others work more broadly to enhance overall immune function.

After care for patients on CAR T-cell therapy 

Immunotherapy increases survival rate by 15% for cancer patients. Therapy should be followed by a period of rest which increases effectiveness. It allows the body to respond to treatment. Here are certain signs and symptoms after therapy a patient feels. 

Fatigue: A patient often feels weak especially during regular work. Here are some things you can do to feel better. 

• Proper rest : Regular sleep for 8 hours and relaxation while doing chores can help you relieve from  weakness. 
• Nutritional plan : Right nutrients at the right time is important. Drink plenty of fluids with a balanced diet including all micronutrients and macronutrients. 

Skin: Immunotherapy often leads to skin rashes, dryness and redness. Skin becomes sensitive to sunlight and certain environmental factors. 

• See your dermatologist: Consult your dermatologist regarding skin changes. Doctors will guide you regarding specific skin concerns and managing certain conditions. 
• Moisturised: Keep your skin hydrated and moisturised properly. Ask your dermatologist according to your skin type. 
• Cleanse: Take clean gloves and clothes to properly clean your body. 

Fever and chills: Patients often feel feverish after therapy. Visit your physician to avoid fever and chills. Take a cold water bath to keep your temperature in check.

Nausea and vomiting: Patients feel uneasy after therapy. Keep your diet simple and stay hydrated. Discuss your medications with physicians. 

Common FAQ’s

What types of cancer can CAR T-cell therapy treat?

Currently, CAR T-cell therapy is primarily used to treat certain types of blood cancers, such as B-cell acute lymphoblastic leukemia (ALL), diffuse large B-cell lymphoma (DLBCL), mantle cell lymphoma, and multiple myeloma. Research is ongoing to expand its use to other types of cancers.

How is CAR T-cell therapy administered?

The process involves several steps: collecting T-cells from the patient’s blood, modifying them in a laboratory to produce CARs on their surface, expanding these modified cells to large numbers, and then reinfusing them into the patient through an intravenous (IV) infusion.

Who is eligible for CAR T-cell therapy?

Eligibility depends on several factors, including the type and stage of cancer, previous treatments, overall health, and specific genetic markers of the tumor. Patients should consult their oncologist to determine if CAR T-cell therapy is a suitable option for them.

Is CAR T-cell therapy expensive?

Car T-cell therapy still remains one of the most expensive treatments. Apart from cost of treatment, doctors, imaging studies and medicine, there is additional cost that adds on to it. The cost of caregiving, housing and travel for repeated monitoring, can lead to extra expenses.

CAR T-cell therapy is only available at certified centers, and it requires you to remain within a 2-hour radius of the center for at least 4 weeks. This may involve significant travel and temporary housing costs, as well as potential loss of income if you are unable to work during this period.

The average cost in other countries is around $373,000 to $475,000, but this doesn’t include additional procedures or healthcare facility expenses. In terms of Indian currency it is almost 3-5 crores. To escape this hefty amount, our homegrown therapy is here to rescue!

NexCAR19, developed by ImmunoACT, is considered one of the most affordable CAR T-cell therapies globally, with an approximate cost of Rs 40 lakh. This breakthrough in cancer treatment offers a potentially life-saving option at a significantly lower price compared to other similar therapies worldwide. Staying in India will cut down on your extra expenses, especially travel and stay. Seek advice from professional regarding cost cutting and best treatment option at minimal cost!

How is CAR T-cell therapy different from other cancer treatments?

CAR T-cell therapy is a form of personalized immunotherapy that specifically uses the patient’s own modified immune cells to target cancer. Unlike chemotherapy or radiation, which attack cancer cells and healthy cells alike, CAR T-cell therapy aims to be more precise by focusing on cancer cells, potentially reducing overall toxicity.

What is the recovery process like after CAR T-cell therapy?

Recovery varies by individual, but it typically involves close monitoring in a hospital or specialized care setting for several weeks to manage any side effects or complications. Patients may need to continue follow-up care and monitoring for several months.