CAR T Cell therapy, a form of cancer immunotherapy, is the current most-exciting field among researchers and oncologists. CAR T-cell therapy is very different and unique and has been shown to eradicate very advanced leukaemia and lymphomas and can keep cancer at bay for many years.
Currently available CAR T-cell therapies are customised for each individual patient. They are made by collecting T cells from the patient and re-engineering them in the laboratory to produce proteins on their surface called chimeric antigen receptors, or CARs. The CARs recognise and bind to specific proteins, or antigens, on the surface of cancer cells, and enable the cancer-killing process.
For decades, the foundations of cancer treatment have been surgery, chemotherapy, and radiation therapy. These continue to be critical mainstays of treatment, but the discovery of Immunotherapy have recently helped transform the paradigm of cancer treatment.
Chimeric Antigen Receptor (CAR) T cells that have been engineered to target CD19 have shown great promise in patients with relapsed and refractory B cell acute lymphocytic leukemia with remission rates of 70-90%.
Some remissions have successfully enabled patients to a curable allogeneic stem cell transplant, whereas some responses have been durable without further treatment, and some patients have achieved durable remissions for relapsed ALL (acute lymphocytic leukemia) after an allogeneic stem cell transplant.
Cytokine release syndrome, correlating with the in vivo activation and expansion of T cells, and neurologic toxicity are the most significant side effects and require better understanding and management, and further clinical studies.
The decision to include CARTs requires an individualised approach taking into consideration the patient, the disease and therapy-related factors.
The CAR-T cells may help guard against recurrence. CAR T cells may eradicate all of the cancer cells and may remain in the body months after the infusion has been completed. The therapy has resulted in long-term remissions for some types of blood cancer
Chimeric antigen receptor T-cell clinical trials have generated impressive results in the early outcomes of CAR-T cell therapy patients with blood cancers.
In some studies, up to 90 percent of children and adults with B-ALL whose disease had either relapsed multiple times, or failed to respond to standard therapies, achieved remission after receiving CAR T-cell therapy. Relapses may be due to the tumor cells losing the expression of the cluster of differentiation (CD-19) antigen, the limited persistence of CAR T cells, or inhibition of CAR-T cell activity.
Studies of CAR-T cell therapy in other blood cancers, including chronic lymphocytic leukemia (CLL), as well as multiple myeloma, also show potential. Research is also under way, exploring the application of CAR T-cell therapy in the treatment of solid tumors.
20 ml of blood is collected from the patient, in a CellnuteTM bottle (Transport Medium). T Cells (a type of immune cell) from the patient is drawn, processed and transformed into CAR T cells in the lab in 20 days. These cells are then sent to the Delhi Vasant Vihar medical centre, where the patient is administered the dose under medical supervision with close monitoring of the patient. A thorough workup is done prior to the administration of the therapy.
Cytokine-Release Syndrome (CRS). This potentially serious side effect is frequently associated with CAR T-cell therapy. Cytokines (chemical messengers that help the T cells carry out their functions) are produced when the CAR T cells multiple in the body and kill the cancer cells. CRS symptoms can range from mild flulike symptoms that include nausea, fatigue, headache, chills and fever. The symptoms of CRS can also be more serious such as low blood pressure, tachycardia, and cardiac complications. CAR T cell therapy may have serious complications, including anaphylaxis, kidney dysfunction and neurological complications. It is best advised to seek medical guidance before opting for this treatment.
