The immune system plays an important role in identifying and managing substances normally present in the body. However, when encountering unfamiliar substances, it triggers a response to eliminate them.
Chimeric antigen receptor (CAR) T-cell therapy utilizes this immune response by modifying T cells, a type of white blood cell, in a laboratory setting. These engineered T cells are designed to efficiently locate and destroy cancer cells. CAR T-cell therapy is often classified as a type of cell-based gene therapy because it involves altering the genetic structure of T cells to enhance their ability to combat cancer.
This innovative approach is particularly valuable for treating certain types of cancer resistant to conventional treatments. It provides a promising alternative when other therapies have proven ineffective. Understanding the cost implications of CAR T-cell therapy in India underscores the need for accessible and effective cancer treatments in diverse healthcare settings. NexCAR19 (ImmunoACT) costs approximately Rs 40 lakh for CAR T-cell therapy in India. It is possibly the least expensive CAR T-cell therapy in the world.
Let’s understand it better!
What is Car T Cell Therapy?
CAR T-cell therapy is an immunotherapy type and a specialized treatment where a patient’s immune T cells are genetically modified in a lab setting. Initially, T cells are extracted from the patient’s blood. Next, these cells are engineered to express a chimeric antigen receptor (CAR) that binds to specific proteins found on the surface of cancer cells. This modification enables the T cells to recognize and attack cancer cells more effectively.
The modified CAR T cells are then cultured in large quantities in the laboratory before being reintroduced into the patient’s body through infusion. This innovative therapy is primarily used to treat certain types of blood cancers and is currently under investigation for its potential in treating other forms of cancer. CAR T-cell therapy is also known as chimeric antigen receptor T-cell therapy.
Also Read: What is Car T-Cell Therapy in India
How Car T-Cell Therapy Works?
T-cells are a type of white blood cell that plays a crucial role in the immune system. They constantly look for abnormal or infected cells. T-cells have receptors on their surface that can recognize specific proteins, called antigens, found on the surface of these abnormal cells, including cancer cells.
Normally, T-cells can recognize and eliminate cancer cells. When a T-cell receptor identifies an abnormal cell, it triggers a response where the T-cell becomes activated. This activation prompts the T-cell to attack and destroy the abnormal cell. Additionally, it signals other parts of the immune system to join in the attack, enhancing the body’s immune response against the threat.
In CAR T-cell therapy, scientists take T-cells from a patient’s blood and modify them in a laboratory. The modification involves adding a gene that encodes a synthetic receptor called a chimeric antigen receptor (CAR). This CAR is designed to recognize a specific antigen found on the surface of cancer cells.
The modified CAR T-cells are cultured and expanded in large numbers in the lab. This step is crucial to ensure that once reintroduced into the patient’s body, there are enough CAR T-cells to effectively target and attack the cancer cells.
After the CAR T-cells have been multiplied, they are infused back into the patient’s bloodstream. These engineered cells circulate throughout the body, seeking out cancer cells that display the specific antigen recognized by their CAR receptors.
When CAR T-cells encounter cancer cells with the targeted antigen, the CAR receptors bind to the antigen on the cancer cell surface. This binding activates the CAR T-cell, triggering it to release cytotoxic substances and proteins that destroy the cancer cell. Importantly, CAR T-cells can also multiply in the patient’s body, providing a sustained and ongoing attack against cancer cells.
The persistence and multiplication of CAR T-cells in the body create a long-lasting effect known as a “living drug.” This term reflects how CAR T-cell therapy continues to actively target and destroy cancer cells over time, potentially providing long-term remission or even a cure in some cases.
CAR T-cell therapy represents an efficient approach in cancer treatment, harnessing the body’s own immune system to specifically target and eliminate cancer cells. It offers new hope for patients with certain types of blood cancers and continues to be studied for its potential in treating other forms of cancer as well.
Into the Car T Cell Procedure
Have a look into the procedure of Car T Cell Therapy:
Before CAR T-cell Therapy
Before undergoing CAR T-cell therapy, the process begins with leukapheresis, where your white blood cells are collected. During this procedure, a machine draws blood, separates out the white blood cells, and returns the rest of the blood back to your body through a central venous catheter.
This collected sample is then transported to a specialized facility where the cells are engineered into CAR T-cells, a process that typically takes three to six weeks. In some cases, chemotherapy or radiation therapy may be administered beforehand to manage the cancer until CAR T-cells are ready. This is known as bridging therapy.
During CAR T-cell Therapy
The actual CAR T-cell therapy begins with lymphodepleting chemotherapy, which helps prepare your body to receive the CAR T-cells without rejecting them. The CAR T-cells are then infused into your bloodstream through an intravenous line (IV).
This infusion process, similar to receiving a blood transfusion, usually takes between five to 30 minutes and may require hospitalization for monitoring.
After CAR T-cell Therapy
Post-treatment, you may experience serious side effects necessitating hospitalization for a week to 10 days. It’s crucial to have someone available around the clock to assist with potential side effects during this time.
Additionally, for the first month after treatment, it’s recommended to stay within close proximity to your treatment center. For up to two months post-treatment, you’ll need assistance with driving, ensuring your safety and well-being as your body adjusts to the CAR T-cell therapy.
Approved CAR T-Cell Therapies
CAR T-cell therapies have gained approval from the US Food and Drug Administration (FDA) for treating specific types of lymphomas, leukemias, and multiple myeloma. Typically used when other treatments have been ineffective, these therapies represent a significant advancement in cancer treatment.
Examples of FDA-approved CAR T-cell therapies include:
- Tisagenlecleucel, also known as tisa-cel (Kymriah)
- Axicabtagene ciloleucel, also known as axi-cel (Yescarta)
- Brexucabtagene autoleucel, also known as brexu-cel (Tecartus)
- Lisocabtagene maraleucel, also known as liso-cel (Breyanzi)
- Idecabtagene vicleucel, also known as ide-cel (Abecma)
- Ciltacabtegene autoleucel, also known as cilta-cel (Carvykti)
Numerous other CAR T-cell therapies and similar treatments are currently undergoing clinical trials, offering hope for expanding their use to other types of cancer. These advancements underscore ongoing efforts to explore new avenues in cancer therapy and improve patient outcomes.
What Conditions Can CAR T-Cell Therapy Treat?
CAR T-cell therapy is currently utilized to treat certain types of blood cancers that have not responded well to other treatments or have relapsed. These include:
- B-cell acute lymphoblastic leukemia (ALL)
- Diffuse large B-cell lymphoma
- Follicular lymphoma
- High-grade B-cell lymphoma
- Mantle cell lymphoma
- Multiple myeloma
- Primary mediastinal large B-cell lymphoma
These conditions represent the primary indications where CAR T-cell therapy has shown efficacy and is being actively used as a treatment option.
Potential CAR T-Cell Therapy Side Effects
CAR T-cell therapy, while effective against tough cancers, can also lead to serious side effects that require careful monitoring in specialized medical centers:
Cytokine Release Syndrome (CRS): CAR T-cells can trigger the release of cytokines, causing symptoms like high fever, chills, trouble breathing, severe nausea, vomiting, diarrhea, dizziness, headaches, rapid heartbeat, fatigue, and muscle/joint pain. Doctors are improving in recognizing and managing CRS early.
Nervous System Issues: Some patients may experience headaches, confusion, seizures, tremors, difficulty speaking, or loss of balance due to nervous system complications. Patients are advised against activities like driving or operating machinery for several weeks post-treatment.
Other Serious Side Effects: Infusion-related allergic reactions, abnormal blood mineral levels (e.g., potassium, sodium), weakened immune system increasing infection risk, and low blood cell counts leading to fatigue, infections, or bleeding are also possible.
Patients receiving CAR T-cell therapy should promptly report any side effects to their healthcare team to receive appropriate medical intervention.
Factors Affecting CAR T Cell Therapy Costs in India
Understanding the factors influencing CAR T-cell therapy costs in India is crucial for patients and healthcare providers alike. Here are some significant factors to consider:
Development and Manufacturing Costs
The initial development and manufacturing of CAR T-cell therapies involve complex and expensive processes, including genetic modification and cell culturing. These costs significantly impact the final price of the therapy.
Clinical Trial and Regulatory Costs
CAR T-cell therapies often undergo rigorous clinical trials to ensure safety and efficacy before approval. Regulatory compliance and associated costs also contribute to the overall expense of bringing these therapies to market.
Technology and Infrastructure
Advanced technologies and specialized infrastructure are required for the production, storage, and administration of CAR T-cell therapies. Investments in these areas influence treatment costs.
Supply Chain Logistics
The logistics involved in transporting patient cells to specialized labs for modification and then back to the treatment center for infusion add logistical complexities and costs.
Hospital Fees and Administration Costs
Hospitals and treatment centers may charge fees for administering CAR T-cell therapy, including healthcare personnel’s expertise in managing these advanced treatments.
Patient-Specific Factors
The overall cost may vary based on the individual patient’s health condition, required dosage, and specific treatment protocol tailored to their needs.
Understanding these factors helps patients and healthcare providers overcome the complexities of CAR T-cell therapy costs in India, ensuring informed decision-making and equitable access to advanced cancer treatments.
Conclusion
While CAR T-cell therapy represents a significant advancement in cancer treatment, its costs in India are influenced by various factors such as development expenses, clinical trial requirements, technological infrastructure, and logistical challenges. Understanding these factors is crucial for ensuring access to this innovative therapy and improving outcomes for patients with challenging blood cancers. Efforts to streamline costs and enhance accessibility are essential for maximizing the potential benefits of CAR T-cell therapy in Indian healthcare settings.
