Car T-cell therapy

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Reason for discussion

 

Recently, the President of India hailed the indigenously developed CAR-T cell therapy for cancer treatment at an event at the Indian Institute of Technology (IIT) Bombay, calling it a major achievement.

 

Car T-cell therapy

 

CAR-T cell therapy or chimeric antigen receptor T-cell therapy is an immunotherapy that uses the patient's own immune system to fight cancer. This therapy is approved for the treatment of leukemia (cancer arising from white blood cell-producing cells) and lymphoma (cancer arising from the lymphatic system).

 

Six CAR-T cell therapies, often referred to as 'living drugs', have received Food and Drug Administration (FDA) approval since 2017. All of these treatments are approved for the treatment of blood cancers, including lymphoma, some types of leukemia and, more recently, multiple myeloma.

 

Process

 

Treatment is a complex and individual process that involves several steps –

 

- T cell collection

T cells, a type of white blood cell that fights infection, are removed from the patient's blood through a process called apheresis.

 

- Genetic engineering

In the laboratory these T cells are genetically modified to express a chimeric antigen receptor (CAR) on their surface.

 

This CAR is specifically designed to recognize and bind to a specific antigen (marker) on cancer cells.

 

- Expansion

The engineered T cells are then multiplied in large numbers in the laboratory.

 

- Infusion

Finally, the expanded CAR-T cells are infused back into the patient's bloodstream, where they can locate and destroy cancer cells displaying the target antigen.

 

Potential benefits of CAR-T therapy

 

- High discount rate

CAR-T therapy can result in high rates of complete remission for some patients with advanced cancer who have not responded to other treatments.

 

- High efficiency

CAR T-cell therapy has demonstrated exceptional efficacy, particularly in patients with certain blood cancers such as acute lymphoblastic leukemia (ALL), chronic lymphocytic leukemia (CLL), and non-Hodgkin lymphoma (NHL). It has achieved significant remission rates in patients unresponsive to other therapies.

 

- Single treatment

Often, CAR T-cell therapy involves a single infusion of genetically engineered T cells, which provides long-lasting therapeutic benefits.

 

This is in contrast to treatments such as chemotherapy, which may require multiple cycles over an extended period of time.

 

Challenges related to CAR T-cell therapy

 

- Cytopenia

CAR T-cell therapy can result in cytopenias, including anemia (low red blood cell count), neutropenia (low white blood cell count) and thrombocytopenia (low platelet count). These conditions increase the risk of infection, bleeding, and other complications.

 

- Tumor lysis syndrome (TLS)

In some cases, the rapid destruction of cancer cells after CAR T-cell therapy can release intracellular contents into the bloodstream, causing metabolic abnormalities such as hyperkalemia, hyperuricemia, and acute kidney injury.

Next step

 

- Cost reduction

Consider strategies to reduce the high cost of CAR T-cell therapy, including negotiating pricing agreements with manufacturers, adopting value-based pricing models, and research and development to optimize manufacturing processes and increase efficiency. Investing in

 

- Management of cytokine release syndrome (CRS).

Develop standardized protocols for early detection and management of CRS, including the use of immunosuppressive drugs (such as tocilizumab) to reduce the inflammatory response.

 

Additionally, improve healthcare provider education and training to recognize and manage CRS, emphasizing the importance of close monitoring and timely intervention.

 

- Management of cytopenia

Implement strategies to reduce the risk of cytopenias associated with CAR T-cell therapy, such as adjuvant care measures (eg, blood transfusions, growth factors) and dose adaptation to reduce hematologic toxicity while maintaining therapeutic efficacy. .