{"id":6258,"date":"2026-01-06T07:29:57","date_gmt":"2026-01-06T01:59:57","guid":{"rendered":"https:\/\/vajiramandravi.com\/upsc-exam\/?p=6258"},"modified":"2026-01-07T11:23:34","modified_gmt":"2026-01-07T05:53:34","slug":"car-t-cell-therapy","status":"publish","type":"post","link":"https:\/\/vajiramandravi.com\/upsc-exam\/car-t-cell-therapy\/","title":{"rendered":"Car T Cell Therapy: Types, Side Effects"},"content":{"rendered":"<p>CAR T cell therapy is a promising new approach in cancer treatment that engineers a patient's T cells to attack their tumours. It involves\u00a0<strong>extracting T cells<\/strong>, genetically modifying them to target\u00a0<strong>cancer antigens<\/strong>, multiplying them and reinfusing the engineered CAR T cells back into the patient's body to provoke a potent immune response against cancer cells.<\/p>\r\n<p>CAR T cell therapy has achieved remarkable outcomes in certain\u00a0<strong>blood cancers,<\/strong>\u00a0but limitations like<strong>\u00a0toxicity risks\u00a0<\/strong>and\u00a0<strong>high costs<\/strong>\u00a0remain. Understanding the mechanism, applications and future potential of this novel immunotherapy can provide insights into cutting-edge medical advances against cancer.<\/p>\r\n<h2>About CAR T Cell Therapy<\/h2>\r\n<p>CAR stands for\u00a0<strong>chimeric antigen receptor<\/strong>. CAR T cell therapy involves collecting T cells from a patient's blood and genetically engineering them to produce\u00a0<strong>special receptors<\/strong>\u00a0called chimeric antigen receptors (CARs) on their surface.<\/p>\r\n<ul>\r\n\t<li>These engineered CAR T cells can recognise and bind to\u00a0<strong>specific protein targets (antigens) on cancer cells<\/strong>. The binding of the CAR T cells to cancer cells signals the T cells to become activated and multiply, and to kill the cancer cells.<\/li>\r\n\t<li>In contrast to general\u00a0<strong>immunotherapies<\/strong>\u00a0that boost the overall immune system, CAR T cell therapy involves engineering a patient\u2019s immune cells to specifically attack their cancer.\r\n\r\n<ul>\r\n\t<li>This makes the therapy a type of\u00a0<strong>personalised cell therapy.<\/strong><\/li>\r\n<\/ul>\r\n<\/li>\r\n\t<li>CAR T cell therapy is being explored as a treatment option for different types of blood cancers including certain<strong>\u00a0lymphomas\u00a0<\/strong>and\u00a0<strong>leukemias.<\/strong><\/li>\r\n\t<li>The two CAR T cell therapies that are furthest along in development target the antigens\u00a0<strong>CD19\u00a0<\/strong>and<strong>\u00a0BCMA<\/strong>, which are found in<strong>\u00a0B cells\u00a0<\/strong>and\u00a0<strong>plasma cells<\/strong>\u00a0respectively.<\/li>\r\n<\/ul>\r\n<h3><strong>Development of CAR T Cell Therapy<\/strong><\/h3>\r\n<p>The concept of CAR T cell therapy has been in development since the late 1980s, but early clinical trials showed limited efficacy and safety.<\/p>\r\n<ul>\r\n\t<li>Advances over the last decade have significantly improved the design of CAR T cells and the clinical protocols, leading to improved safety and efficacy.<\/li>\r\n\t<li><strong>U.S.A:<\/strong>\u00a0Two CAR T cell therapies have now been approved by the\u00a0<strong>US FDA - Kymriah<\/strong>\u00a0in\u00a0<strong>2017\u00a0<\/strong>for\u00a0<strong>B-cell acute lymphoblastic leukaemia<\/strong>, and\u00a0<strong>Yescarta<\/strong>\u00a0in 2017 for diffuse large<strong>\u00a0B-cell lymphoma.<\/strong><\/li>\r\n\t<li><strong>India:<\/strong>\u00a0The Central Drugs Standard Control Organisation (<strong>CDSCO<\/strong>), a drug regulatory body, approved<strong>\u00a0NexCAR19\u00a0<\/strong>for commercial use in October 2023.\r\n\r\n<ul>\r\n\t<li>Developed by\u00a0<strong>ImmunoACT with Tata Memorial Hospital and IIT Bombay,<\/strong>\u00a0it's the first domestically made CAR-T therapy targeting B-cell cancers like leukaemia and lymphoma. It treats individuals\u00a0<strong>above 15\u00a0<\/strong>with\u00a0<strong>B-cell cancers.\u00a0<\/strong><\/li>\r\n\t<li>The therapy showcased its effectiveness with the remarkable recovery of the first patient. Accessible at a\u00a0<strong>fraction of the cost\u00a0<\/strong>compared to international alternatives, it emphasizes its affordability and potential to significantly impact patients' lives.<\/li>\r\n<\/ul>\r\n<\/li>\r\n\t<li>Many other CAR T cell therapies are currently in clinical trials for a range of cancers. Research is also exploring CAR T cell therapies for solid tumours, as well as<strong>\u00a0\"off-the-shelf\"<\/strong>\u00a0CAR T cell therapies using T cells from donors instead of the patient.<\/li>\r\n<\/ul>\r\n<h2>How CAR T Cell Therapy Works?<\/h2>\r\n<p>CAR T cell therapy is a type of immunotherapy that uses genetically modified immune cells to target and kill cancer cells. It is a personalised treatment that involves the following steps:<\/p>\r\n<ul>\r\n\t<li><strong>T cell collection<\/strong>: Patient's T cells are isolated from their blood using\u00a0<strong>apheresis<\/strong>, a process similar to blood donation.<\/li>\r\n\t<li><strong>T cell engineering:<\/strong>\u00a0The collected T cells are genetically engineered to express the chimeric antigen receptor (CAR), using viruses as\u00a0<strong>vectors<\/strong>. This gives the T cells specificity to target the cancer antigen.<\/li>\r\n\t<li><strong>T cell expansion:<\/strong>\u00a0The engineered CAR T cells are grown in the lab to expand their numbers to hundreds of millions. This process takes\u00a0<strong>2-3 weeks<\/strong>.<\/li>\r\n\t<li><strong>Infusion into the patient:<\/strong>\u00a0The expanded CAR T cells are infused back into the patient as an<strong>\u00a0intravenous injection<\/strong>. The patient is usually pretreated with\u00a0<strong>chemotherapy\u00a0<\/strong>beforehand to deplete existing T cells.<\/li>\r\n\t<li><strong>CAR T cells multiply and kill cancer cells:<\/strong>\u00a0In the patient\u2019s body, the infused CAR T cells bind to and kill cancer cells displaying the antigen on their surface. The CAR T cells proliferate and persist in the body, providing an ongoing cancer-killing ability.<\/li>\r\n<\/ul>\r\n<p><img decoding=\"async\" src=\"https:\/\/vajiram-prod.s3.ap-south-1.amazonaws.com\/car_t_cell_therapy_process_58a96328a6.webp\" alt=\"Car T Cell Therapy Process\" \/><\/p>\r\n<h3><strong>Mechanism of Action<\/strong><\/h3>\r\n<ul>\r\n\t<li>The engineered CAR receptor on the T cells binds to the target antigen on cancer cells. This activates the T cell to proliferate and release cytotoxic proteins like\u00a0<strong>perforin\u00a0<\/strong>and\u00a0<strong>granzymes<\/strong>, which enter the cancer cell and trigger cell death.<\/li>\r\n\t<li>CAR T cells also secrete\u00a0<strong>cytokines<\/strong>\u00a0like\u00a0<strong>IL-2<\/strong>\u00a0and<strong>\u00a0IFN-gamma\u00a0<\/strong>that recruit and activate other immune cells to amplify the immune response against cancer cells across the body.<\/li>\r\n\t<li>CAR T cells can persist in the patient for years after\u00a0<strong>infusion<\/strong>, providing durable anti-cancer activity. However, some patients relapse if their cancer stops expressing the target antigen.<\/li>\r\n<\/ul>\r\n<h3><strong>CAR T Cell Generations<\/strong><\/h3>\r\n<ul>\r\n\t<li><strong>First-generation:<\/strong>\u00a0CARs only had the\u00a0<strong>CD3-zeta signalling domain<\/strong>, providing suboptimal activation of T cells.<\/li>\r\n\t<li><strong>Second-generation:<\/strong>\u00a0CARs added a\u00a0<strong>costimulatory domain (e.g. CD28, 4-1BB),\u00a0<\/strong>improving T cell activation and persistence.<\/li>\r\n\t<li><strong>Third-generation:\u00a0<\/strong>CARs contain two costimulatory domains for greater T cell activity but increased toxicity risk.<\/li>\r\n\t<li><strong>Fourth-generation:<\/strong>\u00a0CARs additionally express\u00a0<strong>cytokines<\/strong>\u00a0or other enhancements to improve efficacy and safety.<\/li>\r\n<\/ul>\r\n<p><img decoding=\"async\" src=\"https:\/\/vajiram-prod.s3.ap-south-1.amazonaws.com\/car_t_cell_receptor_enlarge_82c90d2e3b.webp\" alt=\"Car T Cell Receptor Enlarge\" \/><\/p>\r\n<h2>Types of CAR T Cell Therapies<\/h2>\r\n<p>While most approved CAR T cells target CD19 in B cell leukaemias and lymphomas, new targets are expanding applications:<\/p>\r\n<ul>\r\n\t<li><strong>CD19 CAR T Cells: CD19 is a cell surface marker on B cells and B cell cancers.\u00a0<\/strong>\r\n<ul>\r\n\t<li>These cells have induced<strong>\u00a0high remission rates<\/strong>\u00a0in refractory B cell\u00a0<strong>acute lymphoblastic leukaemia (ALL)<\/strong>\u00a0and certain lymphomas.<\/li>\r\n<\/ul>\r\n<\/li>\r\n\t<li><strong>BCMA CAR T Cells: B cell maturation antigen (BCMA)\u00a0<\/strong>is expressed on\u00a0<strong>multiple myeloma cells<\/strong>.\r\n\r\n<ul>\r\n\t<li>These cells have achieved robust response rates in\u00a0<strong>relapsed\/refractory myeloma.<\/strong><\/li>\r\n<\/ul>\r\n<\/li>\r\n\t<li><strong>Other CAR Types:\u00a0<\/strong>CARs targeting antigens like\u00a0<strong>CD20, CD22\u00a0<\/strong>and\u00a0<strong>CD30<\/strong>\u00a0are also being evaluated for\u00a0<strong>hematologic malignancies<\/strong>.\r\n\r\n<ul>\r\n\t<li>CAR T cells targeting<strong>\u00a0solid tumour antigens(e.g. MUC1)<\/strong>\u00a0are in early-phase trials.<\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<h2>Toxicities and Side Effects<\/h2>\r\n<p>CAR T cell therapy has achieved remarkable outcomes in certain blood cancers, but toxicity risks and Side effects remain as follows:<\/p>\r\n<ul>\r\n\t<li><strong>Cytokine release syndrome (CRS):<\/strong>\u00a0Caused by high levels of inflammatory cytokines released by activated CAR T cells. Symptoms may include<strong>\u00a0fever, low blood pressure, difficulty breathing\u00a0<\/strong>and<strong>\u00a0organ toxicities<\/strong>. CRS can be severe or life-threatening in some cases.<\/li>\r\n\t<li><strong>Neurological toxicity:<\/strong>\u00a0Some patients experience neurological issues like\u00a0<strong>delirium, seizures\u00a0<\/strong>or\u00a0<strong>cerebral oedema,<\/strong>\u00a0likely also related to cytokine elevations. These are usually reversible.<\/li>\r\n\t<li><strong>On-target off-tumor toxicity:<\/strong>\u00a0If the target antigen is also expressed on some normal cells, the CAR T cells may cause toxicity to those tissues.\r\n\r\n<ul>\r\n\t<li>For example,\u00a0<strong>CD19 CAR T<\/strong>\u00a0cells can\u00a0<strong>deplete normal B cell<\/strong>s.<\/li>\r\n<\/ul>\r\n<\/li>\r\n\t<li>Other side effects can include\u00a0<strong>infections, anaemia, neutropenia and hypogammaglobulinemia<\/strong>. Supportive care measures are given to manage toxicities.<\/li>\r\n\t<li>Risk mitigation strategies for CAR T cell toxicity include dose adjustment, incorporating safety switches, and<strong>\u00a0cytokine blockade.<\/strong><\/li>\r\n<\/ul>\r\n<h2>Current Challenges and Limitations<\/h2>\r\n<p>Some challenges and limitations need to be overcome before CAR T-cell therapy can be widely applied to solid tumours and haematological malignancies.<\/p>\r\n<ul>\r\n\t<li><strong>Relapses<\/strong>\u00a0can occur in some patients due to antigen escape when cancer cells stop expressing the CAR's target antigen. Combination treatments or CAR T cells targeting multiple antigens may help prevent relapse.<\/li>\r\n\t<li><strong>Efficiency:\u00a0<\/strong>CAR T cell therapies have mostly been successful against\u00a0<strong>blood cancers<\/strong>, with limited efficacy seen so far against solid tumours. Additional bioengineering strategies are being explored to improve solid tumour treatments.<\/li>\r\n\t<li><strong>Toxicity:\u00a0<\/strong>Severe toxicities like\u00a0<strong>cytokine release syndrome<\/strong>\u00a0and neurological issues can occur in some patients after CAR T cell infusion, although usually manageable.<\/li>\r\n\t<li>Complex, personalised manufacturing is logistically challenging.\u00a0<strong>Allogeneic off-the-shelf\u00a0<\/strong>CAR T cell products from donors aim to simplify manufacturing and administration.<\/li>\r\n\t<li><strong>High costs and reimbursement<\/strong>\u00a0difficulties make CAR T cell therapies inaccessible for many patients. Health systems need funding models to improve access.<\/li>\r\n<\/ul>\r\n<h2>Way Forward<\/h2>\r\n<p>CAR T cell therapy is currently very expensive with treatment costing several hundred thousand dollars per patient. The future outlook remains promising - CAR T cell research is surging ahead to:<\/p>\r\n<ul>\r\n\t<li>CAR T cell therapy is poised to become a major advancement in cancer treatment alongside\u00a0<strong>surgery, chemotherapy\u00a0<\/strong>and<strong>\u00a0radiation.<\/strong><\/li>\r\n\t<li>Ongoing innovation is expanding the range of cancer targets and working to\u00a0<strong>improve efficacy, safety\u00a0<\/strong>and<strong>\u00a0accessibility.<\/strong><\/li>\r\n\t<li>It may eventually be an\u00a0<strong>off-the-shelf treatment\u00a0<\/strong>used earlier in cancer therapy, rather than later.<\/li>\r\n\t<li><strong>Combination regimens\u00a0<\/strong>with checkpoint inhibitors, bispecific antibodies or systemic immunomodulators may further enhance<strong>\u00a0CAR T cell potency<\/strong>.<\/li>\r\n\t<li><strong>Next-generation enhancements<\/strong>\u00a0like\u00a0<strong>TRUCKs, ARM T cells<\/strong>\u00a0and the use of\u00a0<strong>iPSC-derived NK or T cells\u00a0<\/strong>may also help overcome current limitations.<\/li>\r\n\t<li>CAR T cell therapy is on the leading edge of\u00a0<strong>personalised cell therapies\u00a0<\/strong>and\u00a0<strong>cancer immunotherapy advances.<\/strong><\/li>\r\n<\/ul>\r\n<p>It is thus spearheading innovation at the confluence of cell engineering, gene therapy and synthetic biology. The decades ahead will see continuous refinements potentiate CAR T cells into a\u00a0<strong>transformative anti-cancer platform technology.<\/strong><\/p>","protected":false},"excerpt":{"rendered":"<p>An overview of CAR T cell therapy, its mechanism of action, the process of engineering T cells, types of CARs, limitations, costs and future applications.<\/p>\n","protected":false},"author":6,"featured_media":20102,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[239],"tags":[710,40],"class_list":{"0":"post-6258","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-quest-level-4","8":"tag-car-t-cell-therapy","9":"tag-quest"},"acf":[],"_links":{"self":[{"href":"https:\/\/vajiramandravi.com\/upsc-exam\/wp-json\/wp\/v2\/posts\/6258","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/vajiramandravi.com\/upsc-exam\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/vajiramandravi.com\/upsc-exam\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/vajiramandravi.com\/upsc-exam\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/vajiramandravi.com\/upsc-exam\/wp-json\/wp\/v2\/comments?post=6258"}],"version-history":[{"count":1,"href":"https:\/\/vajiramandravi.com\/upsc-exam\/wp-json\/wp\/v2\/posts\/6258\/revisions"}],"predecessor-version":[{"id":19873,"href":"https:\/\/vajiramandravi.com\/upsc-exam\/wp-json\/wp\/v2\/posts\/6258\/revisions\/19873"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vajiramandravi.com\/upsc-exam\/wp-json\/wp\/v2\/media\/20102"}],"wp:attachment":[{"href":"https:\/\/vajiramandravi.com\/upsc-exam\/wp-json\/wp\/v2\/media?parent=6258"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vajiramandravi.com\/upsc-exam\/wp-json\/wp\/v2\/categories?post=6258"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vajiramandravi.com\/upsc-exam\/wp-json\/wp\/v2\/tags?post=6258"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}