Indigenous CAR-T Cell Therapy now available for Commercial Use

What’s in today’s article?

• Why in news?
• CAR-T cell therapy
• What is CAR-T cell therapy, and how do CAR-T cells find and destroy cancer cells?
• How effective and different is this from other cancer treatments like, say, chemotherapy?
• NexCAR19
• What is NexCAR19?
• Who can get the NexCAR19 therapy?
• Are children eligible for the therapy too?
• What are the side-effects of this therapy?
• How much will this treatment cost?

Why in news?

• Months after India's drug regulator gave the green light for CAR-T cell therapy, Dr (Col) V K Gupta became one of the first patients to receive the treatment.
  • NexCAR19 is India’s first indigenously-developed CAR-T cell therapy. 
  • In November 2023, the Central Drugs Standard Control Organisation (CDSCO) granted market authorisation for NexCAR19 to ImmunoACT (a company incubated by IIT Bombay).
• Doctors at Tata Memorial Hospital, where Gupta had the procedure, reported that he is now free of cancer cells. Gupta is the first commercial patient to reach this status.

CAR-T Cell Therapy

What is CAR-T cell therapy, and how do CAR-T cells find and destroy cancer cells?

• 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.
• 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 leukaemia and lymphomas.

How effective and different is this from other cancer treatments like 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]. 
• It is a lifeline for non-responsive cancer patients.

NexCAR19

What is NexCAR19?

• NexCar19 is a type of CAR-T and gene therapy developed indigenously in India by ImmunoACT, which is a company incubated at IIT Bombay. 
• This therapy is designed to target cancer cells that carry the CD19 protein. 
  • This protein acts like a flag on cancer cells, which allows CAR-T cells to recognise and attach themselves to the cancer cells and start the process of elimination.
• India is now one of the first developing countries to have its indigenous CAR-T and gene therapy platform.

Who can get the NexCAR19 therapy?

• The therapy is for people with B-cell lymphomas who did not respond to standard treatments like chemotherapy, leading to relapse or recurrence of the cancer.
  • B-cell lymphoma is a type of cancer that starts in white blood cells called lymphocytes. 
  • Lymphocytes make antibodies, which are proteins that help fight infections. 
  • They are often found in lymph nodes or other lymphoid tissues such as the spleen.
• Essentially, patients only need to give a blood sample at their clinic, and come back in 7-10 days for reinfusion.
  • The blood goes to the lab, where the T-cells are genetically modified. In a week to 10 days, these cells return to the clinic for patient reinfusion.
• Recovery typically occurs within two weeks after one cycle of the treatment.

Are children eligible for the therapy too?

• For now, ImmunoACT has received CDSCO approval for use in patients aged 15 years and older.
• The paediatric trial phase is currently underway at the Tata Memorial Hospital, in collaboration with IIT-Bombay. 

What are the side-effects of this therapy?

• NexCar19 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).
  • CRS is characterised by inflammation and hyperinflammation in the body due to the death of a significant number of tumour cells, as CAR-T cells are designed to target and eliminate cancer cells.

How much will this treatment cost?

• Currently, the treatment at a price range of Rs 30-40 lakh and the target to the company is to bring it down to Rs 10-20 lakh.
• As technology matures and manufacturing processes improve, it is anticipated that the cost will decrease.

Q1) What are Lymphocytes?

Lymphocytes are a type of white blood cell that are part of the immune system.

Q2) What is ImmunoACT?

ImmunoACT is a company that develops cell and gene therapies in India. The company was spun out of IIT-Bombay in 2018. ImmunoACT's mission is to provide affordable access to novel autologous CAR-T cell therapies.

Source: Indigenous CAR-T cell therapy now available for commercial use: ‘first’ patient declared free of cancer | Down To Earth | Times of India