CAR T- Therapy

It is a type of treatment in which a patient's T cells (a type of immune system cell) are changed in the laboratory so that they will attack cancer cells. T cells are taken from a patient’s blood.

CAR T-cell therapy. A type of treatment in which a patient’s T cells (a type of immune cell) are changed in the laboratory so they will bind to cancer cells and kill them. Blood from a vein in the patient’s arm flows through a tube to an apheresis machine (not shown), which removes the white blood cells, including the T cells, and sends the rest of the blood back to the patient. Then, the gene for a special receptor called a CHIMERIC ANTIGEN RECEPTOR (CAR) is inserted into the T cells in the laboratory. Millions of the CAR T cells are grown in the laboratory and then given to the patient by infusion. The CAR T cells are able to bind to an antigen on the cancer cells and kill them.

Significance:

· CAR T-cell therapies are even more specific than targeted agents and directly stimulate the patient's immune system to fight cancer, leading to greater clinical efficacy.

· That's why they're referred to as "living drugs."

Challenges:

Preparation:

· The difficulty of preparing CAR T-cell therapies has been a major hindrance to their widespread use.

· The first successful clinical trial was published a decade ago, and the first indigenously developed therapy in India was performed in 2021.

Side Effects:

· In certain kinds of leukaemias and lymphomas, the efficacy is as high as 90%, whereas in other types of cancers it is significantly lower.

· The potential side-effects are also significant, associated with cytokine release syndrome (a widespread activation of the immune system and collateral damage to the body’s normal cells) and neurological symptoms (severe confusion, seizures, and speech impairment).

Affordability:

· Introduction of CAR T-cell therapy in India can face challenges of cost and value.

· Critics argue that developing CAR T-cell therapy in India may not be cost-effective as it will still be unaffordable for most people.

Development in India:

· NexCAR19, an indigenously developed therapy for B-cell cancers, has been collaboratively developed by ImmunoACT, Indian Institute of Technology Bombay (IIT-B), and Tata Memorial Hospital.

· The commercial use of this therapy to treat certain blood cancers was approved by the Central Drugs Standard Control Organisation (CDSCO) in October 2023.

· NexCAR19 is the first CAR-T cell therapy to get CDSCO approval.

Basics

Types of Blood Cells

Red Blood Cells	White Blood Cells	Platelets
· Also called erythrocytes · They are produced in the bone marrow.	· Also called leukocytes · They are cells that exist in the blood, the lymphatic system, & tissues & are an important part of the body's natural defense (immune) system.	· Also called thrombocytes · They are actually tiny cell fragments that circulate in blood & are essential for normal blood clotting.
· They contain hemoglobin, a protein that transports oxygen throughout the body.	· There are five different types of WBCs & each has a different function.	· Dysfunction of platelets, you may be at an increased risk of excessive bleeding & bruising.
· The typical lifespan of an RBC is 120 days.	· WBCs are present in the blood at relatively stable numbers.	· An excess of platelets (thrombocytosis) can cause excessive clotting.

Types of white blood cells (leukocytes)

1. Monocytes: help to break down bacteria.

2. Lymphocytes: They create antibodies to fight against bacteria, viruses, and other harmful invaders.

3. Neutrophils: They kill and digest bacteria and fungi. They are the most numerous types of white blood cell and your first line of defense when infection strikes.

4. Basophils: These cells seem to sound an alarm when infectious agents invade your blood. They secrete chemicals such as histamine, a marker of allergic disease, that help control the body's immune response.

5. Eosinophils: They attack and kill parasites and cancer cells and help with allergic responses.

Lymphocytes are white blood cells that are also one of the body's main types of immune cells.
They are made in the bone marrow and found in the blood and lymph tissue.
The immune system is a complex network of cells known as immune cells that include lymphocytes.
Lymphocytes include natural killer cells, T cells, and B cells.
The B-lymphocytes release an army of proteins into our blood in response to pathogens.
These proteins are called Antibodies (a blood protein produced in response to & counteracting an antigen).
The T-cells themselves do not secrete antibodies but help B cells produce them.
Because these antibodies are found in the blood, the response is also called as humoral immune response.
The second type is called cell-mediated immune response or cell mediated immunity (CMI).

What are the Indian Government’s Initiatives Related to Cancer?

National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke
National Cancer Grid
Encouraging Cervical Cancer Vaccination for girls (9-14 years) (Interim Budget 2024-25)