CAR T-cell Therapy Cost In India
Dr (Col) VK Gupta, a 64-year old Delhi-based gastroenterologist, became the first cancer patient in India to be free of cancer by undergoing India’s CAR T-cell therapy, an indigenous cancer treatment, recently approved by India’s drug regulator. He took this therapy by paying just Rs 42 lakh which would’ve otherwise cost him Rs 4 crore abroad. India’s CAR T-cell therapy, NexCAR19, was developed in India by ImmunoAct (by IIT-Bombay) in collaboration with TATA Memorial Hospital, Mumbai.
What Is CAR T-cell Therapy?
CAR T-cell therapy in India, 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 it only targets the cancer cells, leaving the healthy cells intact.
Our blood comprises three major cell groups: Red, white, and platelets. T-cells or lymphocytes are one of the white blood cells that make up your immune system. During CAR T-cell therapy, these T-cells are collected from your blood. They are separated from the plasma and isolated in labs. Then, the DNA of a cancer-recognizing protein is inserted into the T-cells through a vector to produce chimeric antigen receptors (CARs) on the surface of the cells. It is then reinfused in the patient. These CAR T-cells can detect the cancer cells using the proteins released the on cells and bind with them to kill the cells off.
How Does CAR T-cell Therapy work?
We will have to delve a bit deep into our immune system’s functioning to understand how CAR T-cell therapy works. Our immune system consists of different types of white blood cells or lymphocytes, one of them being T-lymphocytes or T-cells. Your T-cells look for bacteria, fungus or viruses that may linger in your body, and kill them off.
Foreign cells like bacteria, fungus, virus or parasites have their own surface proteins called antigens. But our own T-cells also have certain surface proteins called receptors. These receptors recognise the abnormal antigens, get activated, bind with them, and kill them off. They also activate other parts of the immune system to tackle with the budding disease.
But there are times when T-cells are not able to detect the antigens. It can be due to exhaustion or the inability of the receptors to recognise the antigens. To tackle this problem, scientists change your T-cells by adding a lab-made gene for a chimeric antigen receptor. Next, they make the new CAR T-cells grow and multiply until there are enough cells to target cancerous cells effectively.
Once in your bloodstream, CAR T-cell receptors detect and destroy cancerous cells. The cells also keep on multiplying so you have a long-term supply of CAR T-cells targeting your cancer cells. That long-term supply is why researchers and healthcare providers call CAR T-cell therapy a type of “living drug.”
What Diseases Are Treated With CAR T-Cell Therapy?
At present, CAR T-cell Therapy in India is used to treat certains cancers but clinical trials are going on to expand its scope.
What Is The CAR T-cell Therapy Cost In India?
The CAR T-cell therapy cost in India ranges between USD 50,000 to USD 60,000, depending on the cancer type and the hospital chosen.
Which Hospitals Offer The CAR T-cell Therapy In India?
At present, there are only a few hospitals that offer CAR T-cell therapy in India. These hospitals are renowned for their patient-centric approach in providing treatments. They are also equipped with latest medical technology, providing the best and most affordable treatment with high success rates.
- Max Super Specialty Hospital, Saket, Delhi
- Apollo Specialty Hospital, Chennai
- Kauvery Hospital, Alwarpert, Chennai
- Cytecare Cancer Hospital, Bangalore
- Fortis Memorial Research Institute, Gurugram
- Medanta The Medicity, Gurugram
- Artemis Hospital, Gurugram
- Fortis Hospital, Mulund, Mumbai
- Manipal Hospital, Old Airport Road, Bangalore
- BLK Super Specialty Hospital, Delhi
Who Is An Ideal Candidate For CAR T-cell Therapy?
In an ideal candidate. we generally look for:
- Previous treatment failures: CAR T-cell therapy is an ideal therapy for those patients who have not responded to traditional treatments like chemotherapy or surgery or have experienced relapse.
- Blood cancer: CAR T-cell therapy in India is used primarily for hemotologic cancers like lymphomas and leukemias.
- Specific antigen expression: The cancer cells should express specific antigens targeted by the chimeric antigen receptor (CAR). This is crucial for the modified T-cells to recognise and attack the cancer cells.
What Are The Benefits Of CAR T-Cell Therapy?
- Targets only cancer cells, minimizing harm to healthy tissues.
- Tends to eliminate cancer, leading to sustained remissions, reduction in the risk of relapse or even a cure.
- Effectively treats difficult-to-treat cancers like lymphoma or leukemia.
- Act as “living drugs” that can persist in the body and attack any future cancer recurrence.
- Ideal treatment option when traditional options have failed to treat cancer.
- Notable increase in survival rates among patients who have undergone CAR T-cell therapy in India.
What Tests Are Done Before CAR T-Cell Therapy?
- Complete blood count
- Pulmonary function tests to determine the health of your lungs
- Echocardiogram to assess your heart’s health
- MRI to determine whether your disease has spread to the brain
- Blood tests to assess kidney and liver function
- Tests for infections like HIV and Hepatitis
- CT or PET/CT imaging to determine where the disease is located in your body
- A spinal tap to determine if your disease has spread to your central nervous system
- Bone marrow biopsy or aspiration
CAR T-Cell Therapy Procedure:
Unlike other cancer treatments like chemotherapy, CAR T-cell therapy acts as a precision therapy that only targets the cancer cells without harming healthy cells. This procedure has shown promising results, and the mode of treatment is also straightforward. It doesn’t show any significant side effects before or after the therapy. CAR T-cell is ideal in situations where traditional medicines have stopped responding.
- Eligibility test: The patient undergoes a series of tests to check their eligibility for CAR T-cell therapy in India. Eligibility depends on the type of cancer, its stage, and the severity of the symptoms.
- T-cell collection: The T-cells are collected from the patient’s blood plasma through leukapheresis. The cells are then isolated for further processes.
- Genetic Modification: The DNA for cancer-recognizing protein is introduced into the T-cells to produce chimeric antigen receptors (CARs) on their surface. This process is done through a harmless viral vector. The CAR is designed to recognize specific proteins, called antigens, found on the surface of cancer cells.
- Expansion and Activation: The genetically engineered CAR T-cells are cultured in the lab to increase their number and enhance anti-tumor activity.
- Reinfusion of CAR T-cells: Once sufficient CAR-T cells are available, they are infused back into the patient’s bloodstream through an intravenous catheter. The CAR T-cells are now equipped to recognize and target the specific cancer cells they were engineered to attack.
- Follow-up and Monitoring: After the reinfusion, the patient stays in the hospital for a few weeks and is constantly monitored for side effects.
What Is The Success Rate Of CAR T-Cell Therapy in India?
The success rate of Car T-cell therapy in India is between 60-65%, depending on the type of cancer and its stage. In some cases, the success rate can even touch 70%. As the biopharma ecosystem develops in the country, the costs will decrease and the success rate will increase.
Recovery Time After CAR T-Cell Therapy
Recovery may take up to 2-3 months after CAR T-cell therapy. Patients will be admitted during the first 2–3 weeks to recover from any side effects of chemotherapy before they can be discharged.
What Are The Side Effects Of CAR T-Cell Therapy?
- Cytokine release syndrome: High fever and chills, trouble breathing, severe muscle and/or joint pain, etc.
- Neurotoxicity: Headaches, changes in consciousness, confusion, agitation, weakness, etc.
- Organ Dysfunction
- Risk of infections
Why You Should Opt For CAR T-Cell Therapy In India?
- 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 the CAR T-cell therapy cost in India 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 Happens If CAR T-cell Therapy Fails?
There are hardly any cases of CAR T-cell therapy failing but as it a relatively new technology, the doctors are yet to establish a proper set of protocols. But, a few back-up plans are made available with the doctor to tackle the body’s reaction if the therapy fails, such as:
- Looking at the patient’s condition, the doctors may go for 2nd infustion of CAR T-cells. There have been a few cases where the second infusion of CAR T-cells led to durable responses.
- Another treatment after the failure of first round of CAR T-cell therapy is the use of biospecific antibodies, a form of immunotherapy. These antibodies have two receptors on them, typically designed for one receptor to attach to a T-cell and the other to a cancer cell. The bispecific antibody acts like a pair of handcuffs, bringing the two cells together and making it easier for T-cells to detect and attack the cancer cells.
Other modalities include:
- Chemotherapy
- Targeted therapy
- Chemoimmunotherapy
- Radiation therapy for localized progression
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