CAR T-cell Therapy

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    Context

    • Oncologists explain the importance of CAR T-cell technology in curing people with leukemia and lymphomas.

    Key Takeaways

    • Leukaemia is a type of cancer that affects the blood and bone marrow, while lymphoma is a type of cancer that starts in the cells of the lymphatic system, which is part of the immune system.
    • Ar present,there are three major forms of treatment for any cancer viz.,
      • Surgery: removing the cancer
      • Radiotherapy: delivering ionising radiation to the tumour
      • Systemic therapy: administering medicines that act on the tumour.
    • CAR T-cell therapy is a quantum leap in sophistication in treating these cancers and uses the patient’s own cells, which are modified in the lab to attack tumours.
    • Although the world’s first clinical trial was published a decade ago,the first indigenously developed therapy was done in India in 2021.
    • At present, the cost of treatment is high, over $1 million in the US, with trials underway in India for indigenously manufactured CAR T-cells at a lower cost.
    • As per U.S.-based experts, India is expected to face a ‘tsunami’ of chronic diseases like cancer.

    What is CAR T-cell Therapy?

    • About: Systemic therapy primarily includes:
      • Chemotherapy: preferentially acts on cancer cells but has modest response rates and significant side-effects
      • Targeted agents (immunotherapy): drugs bind to specific targets on cancer cells, has fewer side-effects but is effective only against certain tumours
    • Unlike chemotherapy or immunotherapy, which require mass-produced injectable or oral medication, CAR T-cell therapies use a patient’s own cells to attack tumours.
    • In this therapy, modified cells are infused back into the patient’s bloodstream to activate their immune system against cancer resulting in a more clinically effective treatment, also known as “living drugs”

     

    Advantages of CAR T-cell therapy

    • Personalized Medicine: CAR T-cell therapy is a personalized form of cancer treatment, as the patient’s own immune cells are used to create the CAR T cells.
    • High Efficacy: Clinical trials have shown that CAR T-cell therapy can be highly effective in treating certain types of cancer, particularly blood cancers such as leukemia and lymphoma.
    • Long-lasting response: The CAR T cells can persist in the body for a long time, providing long-lasting immunity against cancer cells.
    • Minimal side effects: Compared to traditional chemotherapy and radiation treatments, CAR T-cell therapy has fewer side effects.
    • Improved Quality of Life: Patients who receive CAR T-cell therapy may experience an improved quality of life, with less fatigue and fewer side effects than traditional cancer treatments.
    • Targeted Therapy: It is a targeted form of therapy, meaning it only attacks cancer cells, reducing the risk of damage to healthy cells and tissues.
    • Non-invasive: Unlike traditional cancer treatments, CAR T-cell therapy is a non-invasive procedure, with the CAR T cells being infused into the patient’s bloodstream.
    • Potential for cure: It has the potential to cure cancer, particularly in patients with otherwise untreatable diseases.

    Challenges in India

    • Complexity of preparation: CAR T-cell therapy requires technical and human resources, making it challenging to administer.
    • Cost: Treatments in the US can cost over a million dollars, making it unaffordable for many patients.
    • Availability: The complexity of preparation has been a major barrier to widespread use, with the first clinical trial showing its effectiveness only a decade ago.
    • Value and access: In India, introducing the therapy faces challenges related to cost and access, with critics arguing that it may not be appropriate or affordable even if made cheaper.
    • Side-effects: CAR T-cell therapy can have significant potential side-effects, such as cytokine release syndrome (widespread activation of the immune system) and neurological symptoms.
    • Response rate: The response rate of CAR T-cell therapy can be variable, with efficacy as high as 90% in some leukaemias and lymphomas but significantly lower in other types of cancers.

    Important types of cell therapies

    • CAR T-cell therapy: This is a type of immunotherapy that involves the genetic modification of a patient’s T cells to express a chimeric antigen receptor (CAR) on their surface. The CAR allows the T cells to recognize and attack cancer cells.
    • Stem cell therapy: This type of therapy involves the transplantation of stem cells to replace damaged or diseased cells. Stem cells have the ability to differentiate into various types of cells, including blood cells, nerve cells, and muscle cells, and can help repair damaged tissue.
    • Dendritic cell therapy: This type of therapy involves the use of dendritic cells, which are immune cells that help to coordinate the immune response against cancer.
    • T-cell therapy: T-cell therapy can involve the activation, expansion, and infusion of T cells with the goal of boosting a patient’s immune response against cancer.
    • Natural Killer cell therapy: This type of therapy involves the infusion of natural killer (NK) cells, which are a type of immune cell that can directly target and kill cancer cells.
    • Mesenchymal stem cell therapy: This type of therapy involves the use of mesenchymal stem cells, which are a type of stem cell that can differentiate into various types of cells, including bone, cartilage, and muscle cells.
    • iPS cell therapy: This type of therapy involves the use of induced pluripotent stem cells (iPSCs), which are adult cells that have been reprogrammed to an embryonic stem cell-like state.

     

    Source: TH