CAR T Cell Therapy Cost in India

Highlights

Cost of CAR-T Cell Therapy in India starts from USD 105,000 and goes upto USD 120,000.
CAR-T cell therapy is a revolutionary treatment used for treating many blood cancers like leukemias and lymphomas.
It is helping many patients to fight cancer when standard treatments like chemotherapy and radiation don’t work.
CAR-T cell therapy is completed in 12-14 days.
The recovery time for the therapy stretches from few weeks to months.
Cytokine release syndrome and Neurological problems are the common risks associated with CAR-T cell therapy.

Chimeric antigen receptor (CAR) T-cell therapy treats certain cancers by transforming your T-lymphocytes or T-cells into more effective cancer-fighting machines. Although long-term data collection is ongoing, CAR T-cell therapy is showing promise as a treatment for some blood cancers.
CAR-T cell therapy is one of the newest and most promising treatments available for blood cancer. These treatments aid in the fight against cancer by utilizing your body’s immune system.
CAR T cell therapy is a kind of cancer immunotherapy treatment that makes use of T cells, which are immune cells, that have undergone genetic alteration in a lab to improve their ability to recognize and eliminate cancer cells.
T cells, as their name suggests, are the foundation of CAR T-cell therapy because they both directly kill pathogen-infected cells and assist in coordinating the immune response.
When other cancer treatments are failing, CAR T therapy can be incredibly successful in treating some cancer types.
The FDA has currently approved CAR T therapy to treat several haematological malignancies, such as: Leukaemia, Lymphoma, Multiple myeloma.
White blood cells called T cells search for and combat infections and disease throughout the body. Antigens are molecules or proteins that the immune system can recognize, and each T cell has a receptor capable of identifying them. The immune system can attempt to eliminate foreign or aberrant antigens once it has identified them.
However, antigens in cancer cells can occasionally exist that the body ignores as aberrant. Consequently, T cells may not be sent by the immune system to combat cancer cells. The T cells might not be able to eradicate the cancer cells in other circumstances.
Receptor chimeric antigen T cells are cells that have undergone genetic modification in a lab. They can attach to and kill cancer cells because they have a new receptor.
Antigens associated with different cancer types vary. Specific cancer antigens are targeted by each type of CAR T cell therapy. Thus, a CAR T cell therapy designed to treat one form of cancer cannot be used to treat another type of cancer.

About CAR T Cell Therapy – How does it work?

Chimeric Antigen Receptor (CAR) T-cell therapy is an immunotherapy in which the patient’s own T cells are modified to recognize and attack the cancer cells. T cells are a part of our body’s immune system and function as killer cells by destroying the abnormal cells. But, unfortunately, these T cells are unable to recognize the cancer cells or destroy them completely.

In this technique, the T cells are collected from the patient’s blood and are genetically engineered in the laboratory so that they recognize the cancer cells as targets. The cells are altered to produce special receptor on their surface, known as chimeric antigen receptors (CARs).

These receptors have the ability to recognize the specific structure (antigen) present on the surface of the cancer cells. This enables the modified T cells, known as CAR T cells, to become activated and attack the tumour cells in the body. A large number of these CAR T cells are grown in the laboratory so that they are sufficient in number and then infused into the patient’s bloodstream to fight cancer.

What types of cancer can be treated by CAR T cell Therapy?

Several CAR T-cell therapies have been approved by the US Food and Drug Administration (FDA) for patients with specific blood cancers that are not responsive to chemotherapy or other treatments. Those with blood cancer who have had prior successful treatments but still have the disease can also be treated with this therapy.

Specialized programs known as risk evaluation and mitigation strategies (REMS) are used to provide CAR T-cell therapy. REMS guarantees that medical professionals are qualified to administer the therapy and are skilled in handling any potentially dangerous side effects.

The following details on the cancers currently being treated with CAR T-cell therapy:

Acute lymphoblastic leukemia in B cells (ALL)

White blood cells or immature B lymphocytes are impacted by this cancer while they are developing in your bone marrow. Bone marrow transplants and chemotherapy are the usual treatments used by providers.

FDA-approved CAR-T cell treatments consist of:

Ticanellecleucel: The medication used to treat ALL in children and young adults
Brexucabtagene autoleucel.

Non-Hodgkin lymphoma in B cells

Diffuse large B-cell lymphoma (DLBCL), follicular lymphoma with DLBCL, and high-grade B-cell lymphoma are among the forms of B-cell non-Hodgkin lymphoma. Stem cell transplantation, monoclonal antibodies, and chemotherapy are the usual treatments used by providers for these conditions.

FDA-approved CAR-T cell treatments consist of:

Tisagenlecleucel.
Ciloleucel Axicabtagene
Asclepias maraleucel

Primary mediastinal large B-cell lymphoma.

FDA-approved CAR-T cell treatments consist of:

Cicloleucel axicabtagene.

Mantle cell lymphoma

This particular kind of non-Hodgkin lymphoma begins in the B cells in your body. Stem cell transplantation and chemotherapy are the usual treatments used by providers.

FDA-approved CAR-T cell treatments consist of:

Brexucabtagene autoleucel (Tecartus®).

Multiple Myeloma

This is a cancer of the cells that produce antibodies, called plasma cells. Stem cell transplantation, targeted therapy, or chemotherapy are the methods used by medical professionals to treat this illness.

The following CAR-T cell therapies have FDA approval:

Idecabtagene vicleucel
Tetrahedron autoleucel.

Researchers are examining the potential benefits of CAR T-cell therapy for patients with non-small cell lung, brain, or breast cancers.

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Making CAR T cells

The T cells are isolated, sent to the lab, and modified by introducing the gene for the particular chimeric antigen receptor (CAR) after the white cells are eliminated. They are therefore CAR T cells. Then, in the lab, these cells are expanded and multiplied. The production of the vast quantity of CAR T cells required for this treatment can take several weeks.

Approved CAR T-cell therapies

The US Food and Drug Administration (FDA) has authorized CAR T-cell therapies for the treatment of multiple myeloma and certain types of leukemia and lymphomas. Usually, CAR T-cell therapy is used following the failure of other forms of treatment.

Currently approved CAR T-cell therapies include, for example:

Tisagenlecleucel, also known as tisa-cel (Kymriah)
Axicabtagene ciloleucel, also known as axi-cel (Yescarta)
Brexucabtagene autoleucel, also known as brexu-cel (Tecartus)
Lisocabtagene maraleucel, also known as liso-cel (Breyanzi)
Idecabtagene vicleucel, also known as ide-cel (Abecma)
Ciltacabtegene autoleucel, also known as cilta-cel (Carvykti)

To treat other forms of cancer as well, numerous additional CAR T-cell therapies and related forms of treatment are currently being investigated in clinical trials.

How is it performed?

CAR T cell therapy is a complex procedure that should only be performed by experts with extensive experience.

Before initiating the therapeutic intervention, the medical practitioner conducts various assessments to determine the suitability of the individual for the procedure. The treatment protocol encompasses a series of sequential steps, which include:

Collection of T cells from the patient

A catheter is inserted by the doctor into a vein in the neck or beneath the collarbone.
The red blood cells and plasma will be returned to the recipient after the white blood cells are extracted from the blood and the catheter is connected to a machine that processes the blood. The term leukapheresis refers to this procedure.

Bio-engineering of the T cells

The T cells collected from the blood are sent to the laboratory where they are genetically altered to express chimeric antigen receptors (CARs) on their surface.

Next, an inactive virus that gives the T cells new genetic instructions is inserted by a doctor.
The T-cells begin producing chimeric antigen receptors (CAR) and other molecules after receiving new genetic instructions.
The receptors end up on the surface of one’s T cells. The molecules are found inside one’s T-cells, where they function as messengers to maintain T-cell activity.
To effectively target cancer cells in the patient’s body, providers take a small batch of CAR T-cells and encourage them to grow and multiply. Until the time comes for the patient to receive them, their new cells are frozen and kept.

Increasing the number of CAR T cells

The number of the modified CAR T cells is expanded in the laboratory until there are millions of such cells. These cells are then frozen and sent to the hospital. This process might take 2 to 6 weeks to complete and have a sufficient number of cells.
One will require chemotherapy before receiving your new cells to prevent your immune system from rejecting them. The infusion of new cells will come after one’s chemotherapy. Patients will likely require hospitalization for this portion of the treatment.

Conditioning

The patient comes to the hospital, around 1 or 2 weeks before the new cell is administered, to receive a brief course of chemotherapy with lympho-depletion drugs. This step is done to remove the normal T cells and create space in the immune system to allow the expansion of CAR T cells.
However, receiving one’s new cells might not require a hospital stay. Should that be the case, the medical staff will keep a close eye on both the procedure and the patient’s development.

Re-infusion of the cells

The CAR T-cells’ receptors will recognize the cancer cells once they are in circulation and attach themselves to the antigens, or proteins, present in cancer cells. Your cells then eradicate the cancerous cells.
The CAR T-cells continue to grow and can search for any new cells containing the target antigen.
At the hospital, the CAR T cells are thawed and then infused into the bloodstream of the patient via a process similar to blood transfusion. These cells are then allowed to proliferate and multiply in the patient’s body.

Most patients require a week to ten days in the hospital for their medical professionals to treat any side effects and keep an eye on how they are responding to the treatment.

The CAR T-cells might be administered to the patient without requiring them to stay in the hospital.

The doctor will continue to keep an eye on the procedure and monitor the advancement if that is the case. One might have to go back to the hospital to finish the procedure for those who experience side effects.

Recovery

Treatment with CAR T cells may have serious or even fatal side effects. For this reason, patients receiving this treatment are typically required to stay in the hospital for a few days for medical professionals to monitor and treat any side effects.

One should arrange to have someone with them around the clock during the first month following treatment. Additionally, one ought to arrange to remain a short drive from the site of the procedure. Additionally, for two months following treatment, one should arrange to have someone drive you where you need to go.

What are the side-effects?

While CAR T-cell therapy has demonstrated remarkable efficacy in treating certain cancers that are difficult to treat, it can occasionally result in severe or even fatal side effects. As a result, it must be administered in a hospital with specialized training in its use, and patients must be closely monitored for a few weeks following their administration of CAR T cells.

Cytokine release syndrome (CRS): As CAR T cells proliferate, they may discharge copious quantities of substances known as cytokines into the bloodstream, thereby enhancing the immune system. This release may cause serious side effects, which include:

High fever and chills
Trouble breathing
Severe nausea, vomiting, and/or diarrhea
Feeling dizzy or lightheaded
Headaches
Fast heartbeat
Feeling very tired
Muscle and/or joint pain

Physicians are learning how to identify CRS early and how to treat it as they become more experienced with CAR T-cell therapy.

Nervous system issues: This medication may occasionally have detrimental effects on the nervous system, which may cause symptoms like:

Headaches
Changes in consciousness
Confusion or agitation
Seizures
Shaking or twitching (tremors)
Trouble speaking and understanding
Loss of balance

Adult patients are usually advised not to drive, operate heavy machinery, or engage in any other potentially dangerous activities for at least several weeks following treatment due to the possibility of these side effects.

Other detrimental effects: The following are additional major adverse effects of CAR T-cell therapy:

Reactions to allergens during infusion
Abnormal blood mineral levels, such as low levels of phosphorus, potassium, or sodium
A compromised immune system and a higher chance of dangerous infections
Low blood cell counts, raise the possibility of infections, exhaustion, and bleeding or bruises.

One must notify the doctor of any side effects as soon as possible for those who are receiving CAR T-cell therapy, as medications can frequently be used to treat them.

CAR T cells are analogous to “giving patients a living drug.”

The foundation of CAR T-cell therapy is, as their name suggests, T cells, which aid in coordinating the immune response and specifically destroy pathogen-infected cells. The CAR T-cell treatments that are currently on the market are tailored to each patient specifically. To create them, T cells are extracted from the patient and modified in a lab to produce proteins on their surface known as chimeric antigen receptors, or CARs. Certain proteins, or antigens, on the surface of cancer cells are recognized and bound to by the CARs.

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What are the success rates of CAR T cell therapy?

Many patients who have undergone CAR T cell therapy showed promising and exciting results. 80% of patients showed reduction or complete elimination of cancer cells after the therapy.

In cases of adults and children treated with Kymriah® therapy, 80% of adults and children with ALL showed remission (recovery period).

This therapy has shown effective results in the challenging cases where the standard cancer treatments – chemotherapy and radiation failed.

Who is a suitable candidate for CAR T cell therapy?

The FDA has approved CAR T cell therapy for patients who have certain types of leukemia or lymphoma that has relapsed/recurred or progressed even after other treatments.

To be eligible for the CAR T cell treatment, the patient must have a history of unsuccessful treatment with least two standard cancer therapies.

Children and adults of up to 25 years of age with advanced and relapsed or refractory acute lymphoblastic leukemia (ALL) are approved for Kymriah® therapy.

Yescarta® is approved for adults with large B-cell non-Hodgkin lymphomas which is aggressive and recurring or has not been fully eradicated after at least two prior cancer therapies.

Written By Vanshika Rawat

Vanshika Rawat is an experienced content developer. She is very knowledgeable in the field of science and healthcare and has worked under brilliant scientists during her higher education. Vanshika obtained her degrees in Masters in Science and Bachelors in Science (Microbiology with Hons.) from renowned institutions - Panjab University and University of Delhi.