Know About India’s CAR T-cell Therapy With Dr Rahul Bhargava

A short rendezvous with Dr Rahul Bhargava, Principal Director & Chief BMT, Fortis Memorial Research Institute, Gurugram, unraveled the mysteries of India’s CAR T-cell Therapy. NexCAR19, the indigenously developed CAR T-cell therapy, has revolutionized the way we view cancer treatment in India. Earlier, we would only talk about treating cancer by managing its symptoms. However, with rapid development in medical technology, India has shifted its focus to curing cancer. After a bone marrow transplant or stem cell therapy, CAR T-cell therapy is here to take the game a notch higher.

Dr Rahul Bhargava shed light on NexCAR19, India’s CAR T-cell therapy indigenously developed by IIT Bombay and TATA Memorial Hospital in Mumbai (Bombay). Developing the country’s first CAR T-cell therapy was the brainchild of Dr. Alka Dwivedi and her team, who spent seven years researching and studying CAR T-cell therapies in the USA to develop a more humanized version for India. But why more humanized? This is so because Dr Dwivedi noticed that the CAR T-cell therapies being used in the USA contained antibody fragments derived from mice, which triggered severe side effects as a patient’s immune system rejected the foreign substance.

CAR T-cell therapy has proven to be highly effective against blood cancers like:

• Diffuse large B cell lymphoma
• Acute lymphoblastic leukemia (ALL)
• Multiple Myeloma

What Is CAR T-cell Therapy?

Dr Bhargava excitingly explained the concept. T-cells are a type of white blood cell called lymphocytes. They help your immune system fight germs and protect you from disease. To help you understand better, think of them as your body’s security guards who stop and kill foreign elements like bacteria or viruses entering your body.

But these cells need to function normally as hyperactive T-cells can lead to autoimmune disorders. On the other hand, exhausted or dysfunctional T-cells can lead to the growth of cancer in your body.

India’s CAR T-cell therapy, also called Chimeric Antigen T-cell therapy, is a type of immunotherapy where your T-cells are genetically modified in a lab to fight cancer. It is one of the precision therapies as, unlike chemotherapy, it only targets the cancer cells, leaving the healthy cells intact.

The CAR T-cell therapy was first envisioned in the USA in 2010. It was given to 10,000 US cancer patients, out of which the condition of at least 100 patients was severe. Post trials, 60% of the participants showed no signs of cancer after completion of the treatment, but quite a few participants showed neurologic side effects.

How Is CAR T-cell Therapy Done?

Dr Bhargava also explained the whole procedure in simple steps. The procedure is similar to a bone marrow transplant with minor changes. Firstly, your T-cells are collected and isolated in a lab. Then, they are genetically engineered by introducing DNA into them to produce chimeric antigen receptors (CARs) on the surface of the cells. The patient is put in remission mode by giving chemotherapy, after which the CAR T-cells are infused into the body via a catheter.

What Makes India’s CAR T-cell Therapy Preferable?

India’s CAR T-cell Therapy is highly preferable over the ones available in the USA because:

• Affordability: CAR T-cell therapy in the USA costs around INR 3 crore to INR 4 crore (USD 361,330 to USD 481,773), whereas India’s CAR T-cell therapy is one-eighth times cheaper at INR 40 Lakhs to INR 50 Lakhs (USD 48,177 to USD 60,221).
• Effectiveness: The success rate of CAR T-cell therapy in India is 65-70%. The treatment is effective even in the later stages of cancer.
• Reduced side-effects: The side-effects of CAR T-cell therapy in India are much less compared to the ones available in the USA due to the use of more human-like antigens.
• Adherence to standards: India’s CAR T-cell Therapy meets all significant international healthcare standards.

What Is The Future Of CAR T-cell Therapy In India?

Dr Bhargava states that India’s CAR T-cell therapy has a bright future. With time, new players will enter this market, ending the monopoly. A biopharma ecosystem will be created to make the therapy more accessible for both domestic and international patients. Companies like Immuneel Therapeutics and Dr. Reddys have already started offering CAR T-cell therapies.