CAR T-Cell Therapy: Empowering Patient's Cells to Fight Cancer!

CAR-T cell therapy is one of the most exciting new ways the medical sector is approaching cancer treatment. A decade ago, immunotherapy was just a far-fetched dream that scientists would talk about in their research. Here we are now, looking at the phenomenal success rates of this treatment!

If you are familiar with immunology and the various advances in the field, this must feel like a revision, right? Don’t worry if you’re learning about this treatment just now; we’ll help simplify the procedure and help you improve your health literacy without a medical dictionary!

So, let’s explore how exactly this therapy empowers a patient’s cells to fight cancer!

What is CAR-T cell therapy?

This therapy uses chimeric (mixture of) antigen receptors as its main weapon to fight against cancer cells. This is a modification done on the T cells. A type of white blood cell that plays an important role in the immune system.

To help jog your memory, the T cells are of three types: helper T cells, cytotoxic T cells, and regulatory T cells. Each plays different roles in the immune system and mostly works to protect the body against significant infections and autoimmune diseases.

Now, what this therapy does is fool the cancer cells that have taken over the immune cells already in the patient’s body.

Think of cancer as the body’s cells turning into its worst nightmare. Cancer cells are normal cells that have become cancerous due to mutations or uncontrolled cell division. So, when these traitor cells overwhelm the immune system, the primary cancer-fighting immune cell - T-cells—becomes weak.

This leads to a weakened immune response by the system against cancer, making T cells ineffective. By now, the patient may already have received a diagnosis from their doctor and may have started the usual course of anti-cancer therapy.

These include medications or radiation whose dose can be quite high, depending on the type and stage of cancer.

For example, the initial stage of cancer may not require a dose of drug that’s significantly harmful for the already weak immune system. However, a later stage of cancer will require a higher dose of medications and radiation therapy, which further damages the healthy cells.

Thus, CAR T-cell therapy acts as the final treatment option when everything else has provided unsatisfactory results.

This is when a novel therapy such as CAR T-cell therapy is employed.

How Does It Work? 

CAR, or Chimeric Antigen Receptor, recognizes the cancer cells present in the body by piggybacking the T cells. Cancer cells express certain special proteins on their surface known as antigen - this helps the T cells (normal and the modified one) recognize and kill it.

Here’s how the process unfolds:

• Step 1: The patient’s blood is collected and taken back to the lab to extract the T cells. Alternatively, a process called leukapheresis helps instantly extract the T cell (from the WBC.) During this step the patient either lies in bed or sits in a reclining chair while two IV (intravenous) lines help complete the process. This step continues for 2-3 hours.

• Step 2: After the T cells are separated out from the WBC, it is sent to a lab and altered by adding the gene for the specific chimeric antigen receptor. And we have the CAR T cell. These cells are grown and multiplied in the lab until there are hundreds of millions of such cells. This is the final product, which will be infused back into the patient’s body.

• Step 3: The revamped T cells (CAR T cells) are sent back into the patient’s body with the help of IV infusion, which is similar to blood transfusion. Once inside the body, these cells will continue growing and killing the cancer cells.

The entire process from collection to re-introduction takes nearly three to five weeks.

But wait, how do scientists know which CAR gene to add in the patient’s T cells? A common question we get asked. Every foreign object for the immune system will contain a protein on its surface that’s not present in the body - the antigen. Cancer cells also express these antigens.

The CAR gene that doctors add to the T cells is decided depending on the type of cancer. The cancer cells are analyzed by doctors and researchers to identify the antigens specific to the patient’s cancer.

This is what helps the immune cells recognize these foreign cells and destroy them. Similarly, cancer cells have these special proteins that are unique to each cancer type (for example, breast cancer will have its own antigen present on the cancer cells than blood cancers.)

Who Is It Suitable For?

This therapy is recommended for certain blood cancers in children, young adults, and a few types of lymphoma or myeloma in adults. Only after other treatments have failed. Here’s a look:

• B-cell Acute Lymphoblastic Leukemia or ALL in both adult and pediatric patients

• Certain types of lymphoma such as DLBCL, primary mediastinal large B-cell lymphoma, large B-cell lymphoma transformed into follicular lymphoma

• Multiple myeloma

The treatment is considered an option only after the patient hasn’t responded to the blood cancer treatments, relapsed, and has adequate organ function.

Potential Side Effects of CAR-T cell Therapy

Just as every treatment has some side effect, which may or may not show up, the therapy has its own set of possible side effects as well.

• Cytokine Release Syndrome: A side effect of CAR-T cell multiplication within the system is the release of chemicals called cytokines in the blood. This chemical ramps up the immune system, which can cause serious side effects such as:

i. High fever or chills

ii. Trouble breathing

iii. Headaches

iv. Muscle or joint pain

v. Severe nausea, diarrhea or vomiting

• Nervous system issues: The treatment can sometimes cause serious side effects on the nervous system, which is also known as ICANS. Immune effector cell-associated neurotoxicity syndrome shows up in the following ways:

i. Changes in consciousness

ii. Headaches

iii. Confusion or agitation

iv. Seizures

v. Shaking or twitching

vi. Loss of balance

vii. Difficulty understanding and speaking

To avoid any mishap after the procedure, doctors recommend against driving, heavy lifting, and other similar activities for at least several weeks.

There are other potential side effects of this treatment, which include-

• Allergic reactions during infusion

• Low blood cell count

• Weakened immune system

• Abnormal mineral levels in the blood

• Increased risk of getting another type of blood cancer

If you experience any of the above signs and symptoms, it is important to immediately inform your doctor or the concerned healthcare team.

CAR-T Cell Therapy Cost

Due to its complex manufacturing, specialized infrastructure, and higher success rates than most novel immunotherapy or radiation therapy options, the cost fluctuates. Globally, the cost of this therapy can range anywhere from $400,000 to $1 million per patient. In India, however, the CAR T-cell therapy Cost is around $68,000.

The cost can vary depending on several factors, a few of which are-

• Chosen country for the procedure

• Type of cancer and whether its is approved for the treatment

• Health insurance plan, particularly if it covers it at all.

What’s Next? 

Now that you know all about the treatment and have an idea about its cost, too, the next step is consulting a specialist. If you have trouble connecting with a specialist, you can simply reach out to us through any one of the channels visible to you.

Our network of oncologists from world-class medical providers such as Turkey, India, Thailand, and the US can help you make the decision.