CAR T-Cell Therapy In India: A New Hope For Cancer Treatment

Suppose a cancer patient has been told that he would be free of cancer cells and return to his normal life; that would be the happiest news for him/her. Well, months after India's drug regulator approved the commercial use of CAR-T cell therapy, a groundbreaking treatment that genetically reprogrammes a patient's immune system to fight cancer. According to a report of The Indian Express, Delhi-based gastroenterologist Dr V.K Gupta has become one of the first patients to receive the therapy for Rs 42 lakh-a treatment that costs around Rs 3-4 crore abroad. Doctors at Tata Memorial Hospital said that “he is currently free of cancer cells” and will be able to go back to his normal routine within a few days.

Well, the landscape of cancer therapy has shifted dramatically over the years, from traditional surgical approaches to the combination of radiation and chemotherapy. However, one of the most promising therapies emerging in oncology is CAR T-cell therapy, a form of immunotherapy that uses genetically engineered cells to target and destroy cancer cells with precision. This innovative treatment, which is already showing promising results globally, holds immense potential in India. This article delves into CAR T-cell therapy, its mechanism, significance, challenges in implementation, and its potential to transform cancer treatment in India.

CAR T-Cell Therapy and Mechanism

CAR T-cell therapy (Chimeric Antigen Receptor T-cell therapy) is one of the most remarkable breakthroughs in this domain, where T cells, a type of immune cell, fight cancer and are genetically modified to recognize and combat cancer cells effectively. T-cells are engineered in the laboratory to produce special receptors on their surface, known as chimeric antigen receptors (CARs). These receptors allow the T-cells to recognize specific proteins in cancer cells, targeting and killing them.

T cells are basically white blood cells that play an important function in the immune system. They are in charge of finding and eliminating contaminated and cancerous cells. T cells develop in the thymus gland, which is located in the chest. Once grown, they move through the bloodstream and lymphatic system, looking for foreign intruders. T cells serve an important role in coordinating immune responses and removing pathogen-infected cells. These cells detect foreign invaders (such as viruses, bacteria, and cancer cells) and launch an immune response against them.

According to a report, The Central Drugs Standard Control Organization, India's counterpart to the US Food and Drug Administration, approved NexCAR19 as the country's first CAR-T cell therapy in October 2023. The approval was based on the findings of two small clinical trials in India, a disclaimer involving 64 persons with advanced lymphoma or leukaemia. According to study findings given in December 2023 at the American Society of Hematology meeting, 67% of patients (36 out of 53) in the two studies showed a significant decrease in the extent of their malignancy (objective response), with about half experiencing a complete response.

NexCAR19 CAR-T treatment is being developed in India by IIT Bombay, Tata Memorial Centre, and industry partner immunoACT. India's first home-grown sophisticated cell and gene therapy for cancer is the world's least expensive CAR-T therapy. Surgery, chemotherapy and radiation therapy have long served as the cornerstones of cancer treatment. Even though new types of treatment have helped revolutionize the therapeutic landscape for cancer patients, including the advent of targeted medicines, they are either short-term or have been linked to relapses after a brief period.

However, with a success rate of more than 80%, CAR T-cell treatment has been effective in preventing relapses in its early stages of testing. As cancer cases in the country are expected to climb in the future years, perhaps exceeding 15 lakh per year beginning next year, and resulting in the deaths of approximately 10 lakh patients, the therapy is poised to revolutionize cancer treatment.

CAR T Cell Therapy: A living drug and how it is effective in battling cancer

CAR T cell therapy is also known as a ‘living drug' for a variety of reasons. CAR T-cell treatment differs from standard drugs in that it uses a patient's immune cells, specifically T cells, rather than chemicals or substances. Because they are living cells, they can grow and reproduce while battling cancer cells for a lengthy period. It is also known as personalized medicine because the treatment is tailored to each patient. Engineering T cells to recognize and attack a specific marker on the patient's specific type of cancer cells provides a personalized strategy. Personalization improves therapy effectiveness.

The primary job of T cells, the white blood cells in your immune system, is to monitor and protect the body against any sort of foreign agent (abnormal cells, bacteria, viruses, fungi, etc.) by detecting proteins known as antigens on the surface of intruder cells. T cells have their own surface proteins, known as receptors. These receptors can identify cells with aberrant antigens. However, T-cell receptors do not always recognize malignant cells. This is where laboratory-engineered CAR T cells are introduced into the human bloodstream; their receptors detect and destroy malignant cells. The cells also continue to proliferate, ensuring a steady supply of CAR T cells that target specific cancer cells. CAR T-cell treatment is referred to as a "living drug" by academics and healthcare practitioners due to its lengthy supply.

Advantages of CAR T cell therapy

High remission rates: CAR T cells have been effective in treating certain malignancies, notably blood cancers such as leukaemia and lymphoma. In rare circumstances, studies have demonstrated remission rates of up to 80%, which exceeds what standard therapy can achieve.

Personalized approach: Unlike chemotherapy and radiation, which target all rapidly dividing cells, CAR T cells are engineered to attack a specific antigen in cancer cells. This personalization minimizes injury to healthy tissues while also reducing adverse effects.

Living drug: As previously stated, CAR T cells are designed to grow and survive within the body. This suggests they can provide long-term protection from cancer recurrence. They function as a living defence mechanism, constantly patrolling for and killing cancer cells.

Cost-effective: CAR T-cell therapy in India costs approximately Rs 40 lakh, which is possibly the world's cheapest CAR T-cell treatment. While in other countries like the US, CAR T-cell treatment is estimated to cost between $500,000 and $1,000,000.

Challenges of CAR T cell therapy

There are some challenges of CAR T cell therapy, which are as follows:

• CAR T cell therapy can have significant side effects, the most famous of which are cytokine release syndrome (CRS) and neurotoxicity. CRS occurs when the injected CAR-T cells cause a huge release of cytokines (small proteins that play an important role in cell signalling within the immune system), resulting in high fever, nausea, headache, low blood pressure, and, in severe cases, organ failure.

• Neurotoxicity can cause confusion, convulsions, and other neurological disorders. CRS and neurotoxicity are both potentially fatal illnesses that frequently necessitate substantial medical care. These side effects require close monitoring and quick management in a hospital setting, emphasizing the importance of proper patient selection and preparation before CAR-T cell therapy.

• The therapy necessitates specialised facilities and knowledge, which are not widely available, limiting its availability to specific regions and organizations.

• Some patients who initially react to CAR-T cell therapy may develop a recurrence. This might happen because of the loss or mutation of the targeted antigen on cancer cells, which is known as antigen escape. As cancer cells develop to resist CAR-T cells, the therapy loses effectiveness, creating a serious obstacle to long-term disease management.

CART Cell Therapy in India

The Government of India has recognized the potential of CAR T-cell therapy and is encouraging research through funding and collaboration with healthcare institutions. According to a report, President Droupadi Murmu launched India's first homegrown gene therapy, NexCAR19, at IIT Bombay on April 4, 2024. Developed by IIT Bombay, Tata Memorial Centre, and ImmunoACT, this CAR-T cell therapy offers a new hope for cancer patients, particularly those with blood cancers. It marks a significant milestone in India's healthcare sector, demonstrating the country's capability in cutting-edge medical research and development.

Medical tourism for CAR T-cell therapy has emerged as a promising avenue for patients seeking advanced cancer treatments. Also, Countries like India, with their world-class medical facilities and cost-effective options, have become popular destinations for international patients. CAR T-cell therapy, a revolutionary treatment that involves genetically engineering a patient's immune cells to fight cancer, offers hope for patients with certain types of blood cancers. By travelling abroad for this treatment, patients can access cutting-edge technology and experienced medical professionals while potentially saving significant costs. For example, Medanta Hospital in Lucknow has accomplished a significant milestone in the field of oncology by successfully treating a leukaemia patient with chimeric antigen receptor T (CAR-T) cell therapy.

The market size of CAR T cell therapy in India

The market of CAR T Cell therapy is expected to grow by USD 3.03 billion at a CAGR of 16.83% between 2023 and 2028. The market's expansion is dependent on several variables, including a growing awareness of the promise of CAR T-cell treatment, rising rates of blood cancer prevalence, and an increase in haematological malignancies.

CAR T cell therapy market globally

CAR T-cell therapy represents a new era in cancer treatment, offering hope for patients who have exhausted traditional treatment options. For India, a country facing a growing cancer burden, CAR T-cell therapy could be transformative. While challenges remain, particularly in terms of cost and infrastructure, the ongoing efforts by the government, private sector, and research institutions signal a promising future. By fostering innovation, collaboration, and investment, India can position itself as a leader in CAR T-cell therapy, potentially paving the way for affordable and accessible cancer care for millions of people.