CAR-T Cell Therapy

 Chimeric Antigen Receptor T-cell (CAR-T) therapy is a revolutionary advancement in the field of cancer treatment, offering hope to patients with certain types of blood cancers where traditional therapies have failed. By harnessing the power of the immune system, CAR-T therapy provides a targeted and personalized approach to combating cancer.

What is CAR-T Cell Therapy?

Chimeric antigen receptor (CAR) T-cell therapy is a new innovative type of immunotherapy in which patient’s own genetically modified T cells are to target and kill cancer cells. In this therapy, the patient’s T cells, a type of immune cells, are collected and their genetic component is altered in a laboratory which enables them to identify the cancer cell receptors and attack them.

CAR-T cell therapy involves reprogramming a patient’s own T cells, a type of white blood cell, to recognize and attack cancer cells. This process includes:

1. T Cell Collection: T cells are collected from the patient’s blood through a procedure called leukapheresis.
2. Genetic Engineering: In a laboratory, the T cells are genetically modified to express chimeric antigen receptors (CARs) on their surface. These receptors enable the T cells to identify specific proteins found on cancer cells.
3. Expansion: The engineered T cells are multiplied to produce millions of copies.
4. Infusion: The modified T cells are infused back into the patient, where they seek out and destroy cancer cells.

A patient has to undergo an extensive evaluation for determining their eligibility for this therapy as it is a highly specialized treatment.

How Does CAR-T Therapy Work?

The engineered CAR-T cells act as a living drug. When infused back into the patient, they:

• Recognize cancer-specific antigens through the CARs.
• Bind to these antigens and become activated.
• Proliferate and release cytotoxic molecules that kill the cancer cells.

This targeted approach ensures minimal damage to healthy tissues, unlike traditional treatments such as chemotherapy or radiation.

Types of CAR-T Cell Therapy Approved by FDA

There are currently two types of CAR T-cell therapy approved by the Food & Drug Administration (FDA) that can be used for some leukemia cases:

1. KYMRIAH: This CAR T-cell therapy is FDA-approved for patients who have:
• Relapsed or refractory diffuse large B-cell lymphoma (DLBCL) in adults.
• Relapsed or refractory acute lymphoblastic leukemia (ALL) in young adult patients up to the age of 25 years.
2. YESCARTA: This was the first CAR T-cell therapy to be approved by the FDA for adult patients with certain types of B-cell lymphoma. The FDA has also approved the use of this therapy for patients who have the following conditions and either do not respond to or have relapsed following the standard line of treatment for these cancers:
• Diffuse large B-cell lymphoma (DLBCL)
• Primary mediastinal B-cell lymphoma
• High-grade B-cell lymphoma
• DLBCL that results from follicular lymphoma

Steps in the CAR-T Therapy Process

Patients who are approved for CAR T-cell therapy will undergo the following steps:

1. Collection of Cells: A technique called leukapheresis is used to harvest the white blood cells (including T cells) from the patient’s body.
2. Genetic Modification: The collected cells are sent to the manufacturing laboratory, where the T-cells are genetically altered using biotechnology tools to express a specific protein called chimeric antigen receptors (CARs) on their surface. This helps identify the targeted cancer cells.
3. Multiplication of Modified Cells: The genetically modified T cells are allowed to grow in the lab, to increase their number. When a sufficient amount of cells have grown, they are frozen and sent to the Cancer Center. This whole process takes about 2 to 3 weeks to complete.
4. Conditioning Chemotherapy: Patients will receive chemotherapy in the meantime, actually a few days prior to the infusion. This therapy is given to improve the ability of the CAR T-cells to expand and multiply in the body.
5. Infusion of CAR T-cells: Patients receive the CAR T cells as an infusion that goes directly into their bloodstream as a single infusion, similar to the process of a blood transfusion. This requires a hospital stay for 1-2 weeks after the infusion so that the medical team can monitor the patients for any potential side effects.

Cost and Availability of CAR-T Therapy in India

Traditionally, CAR-T cell therapies have been prohibitively expensive, with costs in the United States reaching approximately $400,000 per infusion. However, in India, homegrown CAR-T cell therapies have substantially reduced this financial burden.

The cost can depend on several factors:

• Treatment procedure
• Technology used
• Severity of defect
• Location
• Pre- and aftercare
• Services included

Similarly, the costof chemotherapy in India that lasts over a period of six months is between $2500 to $3500. This includes the session fees and the cost of chemotherapy drugs. However, the same drugs and treatment cost around $28000 to $30000 in the US, eight to nine times more than what it costs in India. The cost can depend on several factors:

• Treatment procedure
• Technology used
• Severity
• Location
• Pre- and aftercare
• Services included

Note: The treatment costs vary from case to case and a specialist review is advised to determine the best procedure/approach for treatment. Several external factors also impact the cost & quality of treatment including the method of treatment, room category, and several other factors. Please contact Lyfboat Care Team for a personalized quote and advise.

 Hospitals Offering CAR-T Cell Therapy in India

Several leading hospitals in India have begun offering CAR-T cell therapy:

• Apollo Hospitals: One of the first private hospital groups in India to successfully complete CAR-T cell therapy, Apollo Cancer Centres provide this treatment across multiple locations.
• Artemis Hospital, Kochi: It has introduced CAR-T cell therapy for blood cancers, marking a significant milestone in the region's medical advancements.
• Tata Memorial Centre, Mumbai: This renowned institution has successfully treated patients with blood cancers such as leukemia and lymphoma using CAR-T cell therapy.

Success and Applications

CAR-T cell therapy has shown remarkable success in treating certain hematologic malignancies, including:

• Acute Lymphoblastic Leukemia (ALL): Particularly in children and young adults.
• Diffuse Large B-Cell Lymphoma (DLBCL): The most common type of non-Hodgkin lymphoma.
• Multiple Myeloma: Approved therapies are demonstrating promising results.

The therapy is continually being researched and expanded to treat other cancers, including solid tumors.

Conclusion

CAR-T cell therapy represents a paradigm shift in cancer treatment, offering a beacon of hope to patients with few alternatives. As research progresses, this innovative therapy has the potential to become more accessible, affordable, and effective, transforming the landscape of oncology.