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CAR T-cell therapy represents a groundbreaking approach to harnessing the power of the body's immune system to combat cancer. By modifying T cells, a subset of white blood cells, in a laboratory setting, these cells are empowered to recognize and eliminate cancer cells with precision. Often categorized as a form of cell-based gene therapy, CAR T-cell therapy involves altering the genetic makeup of T cells, equipping them with the ability to target specific cancer antigens.
This innovative treatment has demonstrated remarkable efficacy, particularly in cases where conventional therapies have proven ineffective. Its ability to reprogram the immune system to target and destroy cancer cells marks a significant advancement in cancer treatment strategies.
Classification:
CAR T cell therapy is classified as follows:
- Structure-based classification:
- First-generation CAR T-cells: These CAR T-cells typically consist of an antigen-binding domain (single-chain variable fragment, scFv) linked to a T-cell activation domain, such as the CD3ζ chain. They lack additional co-stimulatory domains.
- Second-generation CAR T-cells: These CAR T-cells include an additional co-stimulatory domain, such as CD28 or 4-1BB (CD137), along with the CD3ζ chain. The presence of co-stimulatory domains enhances T-cell activation and persistence.
- Third-generation CAR T-cells: These CAR T-cells incorporate two co-stimulatory domains along with the CD3ζ chain, aiming to further enhance T-cell function and anti-tumor activity.
Antigen-based classification: It includes
- CD19-targeted CAR T-cells: CD19 is a common target for CAR T-cell therapy and is used in the treatment of B-cell malignancies such as acute lymphoblastic leukemia (ALL) and certain types of lymphoma.
- Other antigen-targeted CAR T-cells: CAR T-cells can be engineered to target a variety of antigens expressed on cancer cells, including but not limited to BCMA (B-cell maturation antigen), CD22, CD30, and EGFRvIII.
CAR T-cell therapy is primarily used to treat blood cancers, such as multiple myeloma, large B-cell lymphoma, and B-cell acute lymphoblastic leukaemia. The patient's own T cells are reprogrammed to identify and destroy cancer cells, cause remission, enhance survival, and have a plan B in case other treatments fail.
Patients with blood cancers who relapsed or are refractory must consult an oncologist to determine candidacy for CAR T therapy, especially if they have failed to respond to traditional treatments (i.e., chemotherapy, radiation, or stem cell transplant). Evaluation is warranted for symptoms such as loss of weight, swelling of lymph nodes, recurrent infection, chronic fatigue, or spontaneous bruising.
Screening tests consist of imaging, bone marrow biopsy, and blood work.Leukapheresis is utilised to harvest T cells from the patient's blood for T-cell collection.Bridging therapy: Certain patients receive chemotherapy while waiting for CAR T cells to be produced.Lymphodepleting chemotherapy is administered before the injection to make room for CAR T cells. The patients should plan for potential hospitalisation, designate caretakers, and discuss long-term follow-up and expected adverse effects with the medical team.
- T-cell harvesting: T cells are removed from the patient's blood by processing.
- Genetic alteration: T cells are designed in the laboratory to express CAR proteins targeting cancer cells.
- Expansion: Modified T cells are expanded to therapeutic levels.
- Infusion: Patient receives an intravenous infusion of CAR T cells.
- Monitoring: Intensive monitoring, often in the hospital, for side effects and reactions.
The whole process, from cell harvesting to infusion, can take three to six weeks. The infusion itself takes a few hours to a few minutes, but for at least one week following the infusion, close monitoring is required, and there will be frequent follow-ups for several months.
- Cytokine Release Syndrome (CRS)
- Neurotoxicity
- Infections
- Low blood counts
- Relapse or non-response
One of the newer treatment options for some blood cancers is CAR T-cell therapy. It is utilised when other treatments are not working or the cancer recurs. CAR T-cell therapy has the potential to cure many blood cancers and extend life in most cases.
Recovery involves managing side effects like CRS and neurotoxicity, monitoring blood levels, and avoiding infections. Laboratory testing, imaging, and monitoring for late issues like hypogammaglobulinemia or relapse are all included in long-term follow-up.
The nature of the cancer, the burden of the disease, and an individual's response all impact success. For example, in pediatric acute lymphoblastic leukaemia, complete remission rates are more than 80%. However, relapse is always a risk, and long-term success is variable.
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VPS Lakeshore Hospital
Kochi, India
VPS Lakeshore Hospital located in Kochi, India is accredited by NABH. Also listed below are some of the most prominent infrastructural details:
- Advanced hi-tech healthcare facility
- Innovative diagnostic & therapeutic medical technologies
- Diagnostic endoscopy of nose, esophagoscopy, Laryngoscopy, Bronchoscopy
- Cardiac department- Coronary Artery Bypass Grafting, Total Arterial Coronary Revascularization, Heart Valve Repairs and
- Replacements, Surgery for Heart Failure, Intracardiac Repair of Congenital Anomalies of the Heart, Surgery for Atrial Fibrillation
- Neurosurgery department: Keyhole Surgery for disc & other spine disorders, such as Spine Tumors, Navigation-guided, and Endoscopic Brain Tumor Surgery, Minimally invasive Brain Surgery, Advanced Head Injury Management with the ICP Monitoring
- State-of-the-art-hemodialysis Units
- Kidney Transplantation is done with Laparoscopic Donor Nephrectomy
- 24 hour rapid TAT team equipped with four specialists have increased survival and decreased patient morbidity
- Joint preservation techniques include autologous chondrocyte implantation
- Cutting edge operation theaters & world-class transplant ICUs
- Urology department: 3D Laparoscopy, Minimally Invasive Surgery, Ureteroscopy, RIRS, Endourology: PCNL
- Objective swallowing evaluation services such as functional endoscopic evaluation of Swallowing & Video Fluoroscopic Swallow
Rajagiri Hospital
Kochi, India
- Rajagiri Hospital, Kochi, Kerala, is a leading multi-speciality tertiary care hospital known for providing world-class medical services with advanced technology and compassionate care.
- Accredited by JCI, NABH, and NABL, the hospital offers comprehensive treatment across specialities like Cardiology, Oncology, Neurology, Gastroenterology, Orthopaedics, Nephrology, Urology, and Paediatrics, making it a trusted healthcare destination in South India.
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