‘First’ patient free of cancer: Indigenous CAR-T cell therapy brings treatment cost down from Rs 4 crore to Rs 40 lakh

Subject: Science and tech

Section: Health

Context:

Dr (Col) V K Gupta has been declared cancer-free since he took the indigenously developed CAR-T cell therapy at Mumbai’s Tata Memorial Hospital.

More on news:

The therapy is developed by ImmunoAct, IIT Bombay and Tata Memorial Hospital, the therapy has been administered to 15 patients in India.
Months after India’s drug regulator approved the commercial use of CAR-T cell therapy, a pioneering treatment that genetically reprogrammes a patient’s immune system to fight cancer, Gupta, a Delhi-based gastroenterologist, became one of the first patients to access the therapy by paying Rs 42 lakh.
Doctors at the Tata Memorial Hospital, where he underwent the procedure, said he is “currently free of cancer cells”, the first commercial patient to achieve that status.

About NexCAR19:

NexCAR19 is the indigenously developed therapy that Gupta underwent, is a treatment for B-cell cancers (types of cancers that form in the immune system’s cells) such as leukemia and lymphoma.
It has been developed collaboratively by ImmunoACT, a company incubated at the Indian Institute of Technology Bombay (IITB), IIT-B and Tata Memorial Hospital.
The commercial use of this therapy was approved by the Central Drugs Standard Control Organisation (CDSCO) in October 2023.
NexCAR19 is available in over 30 hospitals in more than 10 cities in India.
Patients over the age of 15 years who suffer from B-cell cancers are eligible for this one-time therapy at these centers.
Currently, the treatment cost is in a price range of Rs 30-40 lakh for CAR-T therapy.
The ultimate goal is to bring the cost down to Rs 10-20 lakh.

Who can get the NexCAR19 therapy?

The therapy is for people with B-cell lymphomas who didn’t respond to standard treatments like chemotherapy, leading to relapse or recurrence of the cancer.
Recovery typically occurs within two weeks after one cycle of the treatment.
In our data, approximately 70% of patients respond to the treatment, with variations between leukemia and lymphoma cases.
About 50% of these responsive patients achieve a complete response.

About CAR-T cell therapy:

As part of the therapy, the patient’s T-cells (types of immune cells) are collected and genetically modified into potent cancer fighters known as CAR-T cells so that they express chimeric antigen receptors (CARs) specific to cancer cells.
The modified CAR-T cells are then expanded in the laboratory before being infused back into the patient.
These engineered cells recognise and attack cancer cells, with a focus on B-cell cancers, thus offering a targeted and potent immunotherapy.
CAR-T is a revolutionary therapy that modifies immune cells, specifically T-cells, by turning them into potent cancer fighters known as CAR-T cells.
T-cells are special cells (white blood cells that find and fight illness and infection) whose primary function is cytotoxic, meaning it can kill other cells.
In CAR-T therapy, we genetically modify them into cancer-fighting cells.
These supercharged cells are then put back into the body, and they go after cancer cells — especially in blood cancers like leukemia and lymphomas.

Is India’s indigenous CAR-T cell therapy any more or less effective than CAR-T cell therapies abroad?

Specifically, it leads to significantly lower drug-related toxicities.
It causes minimal damage to neurons and the central nervous system, a condition known as neurotoxicity.
Neurotoxicity can sometimes occur when CAR-T cells recognise the CD19 protein and enter the brain, potentially leading to life-threatening situations.
The therapy also results in minimal Cytokine Release Syndrome (CRS), which is characterized by inflammation and hyperinflammation in the body due to the death of a significant number of tumor cells, as CAR-T cells are designed to target and eliminate cancer cells.

First CAR-T cell therapy to get CDSCO approval

Immuno ACTs is the first CAR-T cell therapy to get CDSCO approval in many hospitals, including Chandigarh-based Postgraduate Institute of Medical Education and Research (PGIMER).
They are also conducting groundbreaking clinical trials in the use of CAR-T cell therapy to treat cancer.
The commercial use of this therapy to treat certain blood cancers was approved by the Central Drugs Standard Control Organisation (CDSCO) in October 2023.
Pulitzer Prize-winning oncologist Siddhartha Mukherjea is also conducting his first phase II multicentre CAR-T cell therapy study. His start-up Immuneel is working on the therapy.

How effective and different is this from other cancer treatments like, say, chemotherapy?

While chemotherapy and immunotherapy may add a few months or years to a cancer patient’s life, cell-and-gene therapy is designed to cure and provide lifelong benefit.
It makes treatment easier with a one-time therapy (unlike several sessions of chemotherapy) that can be truly transformative for a patient.
It’s a lifeline for non-responsive cancer patients.