Chimeric antigen receptor (car) T cell therapy

R. Gobinathan*

Junior Clinical Pharmacist, Kauvery Hospital, Cantonment, India

*Correspondence: clinical.cst@kauveryhospital.com

Aim

The objective of this paper is to present an overview of the car T cell therapy and its therapeutics application.

Backgound

CAR T-cell therapy is a form of immunotherapy that uses genetically modified immune cells to fight cancer. CAR T-cell is a way to get immune cells called T cells (a type of white blood cell) to fight cancer by changing them in the lab so they can find and destroy cancer cells. CAR T-cell therapy is also sometimes talked about as a type of cell-based gene therapy, because it involves altering the genes inside T cells to help them attack the cancer. In CAR T-cell therapies, T cells are taken from the patient’s blood and are changed in the lab by adding a gene for a receptor (called a chimeric antigen receptor or CAR), which helps the T cells attach to a specific cancer cell antigen. The CAR T cells are then given back to the patient. Since different cancers have different antigens, each CAR is made for a specific cancer’s antigen [1].

Car T therapy Process

T cells are collected from a patient. T cells are collected via apheresis, a procedure during which blood is withdrawn from the body and one or more blood components (such as plasma, platelets or white blood cells) are removed. The remaining blood is then returned to the body.

T cells are reengineered in a laboratory. The T cells are sent to a laboratory or a drug manufacturing facility where they are genetically engineered, by introducing DNA into them, to produce chimeric antigen receptors (CARs) on the surface of the cells.

After this reengineering, the T cells are known as “chimeric antigen receptor (CAR) T cells.” CARs are proteins that allow the T cells to recognize an antigen on targeted tumor cells.

The reengineered CAR T cells are then multiplied. The number of the patient’s genetically modified T cells is “expanded” by growing cells in the laboratory. When there are enough of them, these CAR T cells are frozen and sent to the hospital or center where the patient is being treated.

At the hospital or treatment center, the CAR T cells are thawed and then infused into the patient. Many patients are given a brief course of one or more chemotherapy agents, called “lymphodepletion,” before they receive the infusion of CAR T cells. CAR T cells that have been returned to the patient’s bloodstream multiply in number. These are the “attacker” cells that will recognize, and attack, cells that have the targeted antigen on their surface [2].

FDA approved Car T therapy treatment

CAR T-cell therapies are approved by the US Food and Drug Administration (FDA) to treat some kinds of lymphomas and leukemia’s, as well as multiple myeloma. CAR T-cell therapy is typically used after other types of treatment have been tried.

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)[3]

Current scenario of car T cell therapy in India

CAR-T cell therapy is not yet available as a full-fledged treatment in India. It is still in the clinical trial phase. The first phase of clinical trials for CAR T cell therapy in India was conducted by Tata Memorial Hospital and IIT Bombay. According to IIT Bombay, HCAR19 tested in a phase 1 clinical trial in adult lymphoma has been shown to be safe and encouraging early signals of efficacy. After the approval of the Central Drug Quality Control Organization, the clinical trials will now enter Phase II clinical trials. A phase II clinical trial demonstrated an overall response rate of 77% at day 90 in patients with leukemia and lymphoma. India is currently conducting phase 3 trials for car-t cell therapy. India has obtained very positive results in the earlier phases of clinical trials. CAR T cell therapy is used as third or second-line treatment for patients with specific types of cancers. In India, those willing to undergo this treatment have to travel to other countries, mostly the US [4].

The cost of car T cell therapy in India

CAR-T cell therapy is not yet commercially available in India. It is still in the clinical trial phase. However, if you want to undergo CAR-T cell treatment in India, you can get this treatment for free. Car-t cell therapy in India is expected to be available commercially in early 2024.

Conclusion

Treatment using chimeric antigen receptor T cell (Car T cells) represents a new era in medicine. It is likely to be the biggest innovation in the pharmaceutical industry. Car T cell therapy is revolutionizing the way cancers are treated, by modifying the patient’s own immune system to recognize, and then attack the cancer cells.

Reference

R. Gobinathan

Junior Clinical Pharmacist

Chimeric antigen receptor (car) T cell therapy