CAR T-Cell therapy in lymphoma

CAR T-cell therapy is a viable treatment option for some individuals with non-Hodgkin lymphoma (NHL) who have relapsed or who have failed to respond to prior treatments (refractory). It’s a highly sophisticated treatment that entails genetically altering a patient’s own T cells in order to combat cancer. Several CAR T-cell treatments for lymphoma have been authorised by the FDA. Dana-Farber/Brigham and Women’s Cancer Center (DF/BWCC) is one of the first cancer institutes to offer FDA-approved CAR T-cell therapy to patients who have failed to respond to other treatments. The FDA has approved CAR T-cell treatments for the following uses:

DLBCL, primary mediastinal B-cell lymphoma, and transformed follicular lymphoma are all examples of aggressive relapsed or refractory large B-cell lymphoma.

Yescarta (axicabtagene ciloleucel): In clinical studies for specific types of aggressive non-Hodgkin lymphoma, 82 percent of patients responded to CAR T-cell treatment, with 54 percent of patients having a full response (i.e., no sign of cancer). The most current follow-up data, collected at a median of 27.1 months after treatment, revealed that 39% of patients had a continued response, demonstrating the therapy’s long-term effectiveness.

 

CAR T-Cell therapies approved in treatment of lymphoma

KYMRIAH® (tisagenlecleucel): In a clinical trial, 53 percent of patients with aggressive non-Hodgkin lymphoma responded to treatment, with 40% attaining a full response (i.e., no sign of cancer). KYMRIAH is also approved for those under the age of 25 who have relapsed or refractory B-cell acute lymphoblastic leukaemia (ALL). Find out more about KYMRIAH, a treatment for paediatric B-cell ALL.

Breyanzi (lisocabtagene maraleucel): 73 percent of patients with large B-cell lymphoma responded to the medication in a clinical trial, with 54 percent having a full response. 

Mantle cell lymphoma that has relapsed or is refractory. 

Tecartus (brexucabtagene autoleucel, formerly KTE-X19): 87 percent of patients reacted to the medication in the clinical study, with 62 percent having a full response.

Follicular lymphoma that has relapsed or is refractory.

Yescarta (axicabtagene ciloleucel): In a clinical trial, 91 percent of patients responded to the drug, with an estimated 74 percent remaining in remission after 18 months.

Patients can participate in clinical studies of CAR T-cell therapy for different types of lymphoma, as well as trials of CAR T-cell therapy early in treatment and in conjunction with other immunotherapies, through our programme.

CAR T-Cell therapy can be a very good treatment for patients with aggressive Non-Hodgkin lymphoma & certain types of leukemia in children and young adults have recently been approved by FDA (Food and drug administration).  This cell therapy is useful for treatment in certain children and young adults suffering from Non – Hodgkin lymphoma. Treatment with Yeskarta & Kymriah is the first CAR T-Cell therapy to receive FDA approval.

Novartis manufactures tisagenlecleucel, which is used for patients up to the age of 25 suffering from B-Cell ALL that is not responding to other forms of treatment or has relapsed two or more times.

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CAR T Cell therapy for treatment of lyphoma in India

What is CAR T-Cell therapy (Chimeric antigen receptors) ?

CAR T-Cell therapy is a form of immunotherapy that uses specially modified T-cells which are part of our immune system to fight cancer. A sample of patients T cells are collected from the blood, then it is modified to to produce special structures called chimeric antigen receptors (CAR) on their surface. When these modified CAR cells are re infused in the patient, these new cells attacks the specific antigen and kills the tumour cells.

How CAR T-Cell therapy works ?

CAR T-cell therapy takes help from body’s own immune system to attack and kill cancer cells. This is done by removing some specified cells from the blood of the patient, modifying them in the lab and re injecting them into the patient. CAR T-cell therapy has produced very encouraging results in Non-Hodgkin lymphoma and thus approved by FDA.

Who are the right candidates for CAR T-Cell therapy ?

At present FDA has approved CAR T-Cell therapy for some forms of aggressive and refractory Non-Hodgkin lymphoma and relapsed and refractory acute lymphoblastic leukemia. Patient need to send full medical reports to ascertain the use of CAR T-Cell therapy for his treatment.

Inclusion criteria for CAR T-cell therapy:

1. Patients with CD19+ B-cell Lymphoma(At least 2 prior combination chemotherapy regimens)

2. To be aged 3 to 75 years

3. ECOG score ≤2

4. Women of childbearing potential must have a urine pregnancy test taken and proven negative prior to the treatment. All patients agree to use reliable methods of contraception during the trial period and until follow-up for the last time.

CAR T Cell therapy in India pic

 

Exclusion criteria for CAR T-cell therapy :

1. Intracranial hypertension or unconsciousness

2. Respiratory failure

3. Disseminated intravascular coagulation

4. Hematosepsis or Uncontrolled active infection

5. Uncontrolled diabetes

What are the possible side effects of CAR T-cell therapy ?

Most of the patients on chemotherapy experience some sort of side effects like hair loss, nausea, and vomiting, however, these side effects are not commonly seen with CAR T-Cell therapy. Having said that patients may suffer from many other side effects and thus patients are usually kept admitted under observation for several weeks.

Possible side effects from CAR T-cell therapy include:

  • Cytokine release syndrome: CAR T cells can initiate a massive release of substances called cytokines, which triggers an inflammatory condition known as cytokine-release syndrome (CRS). Symptoms may be flu-like, with a high fever and/or chills; low blood pressure; difficulty breathing; or confusion. These symptoms can be mild or severe.
  • Neurologic difficulties: Patients may also experience confusion, difficulty understanding language and speaking, or stupor.

You may like to read : Car T-Cell therapy in China

CAR T Cell therapy in India pic 3

Treatment process for CAR T-Cell therapy ?

  • Complete evaluation of the patient
  • T-cell collection from the body
  • T-cells are then engineered in the lab
  • Genetically engineered T-Cells are then multiplied by using growing them in the laboratory. These cells are frozen and then sent to the treating centres.
  • Prior to infusing, patient may be given chemotherapy for their cancer. This helps the therapy work in a better way.
  • Soon after chemotherapy CAR T-Cells are infused by a process which is similar to blood infusion.
  • There is a 2-3 month of recovery period for the patient.

Time frame for CAR T-Cell therapy

1. Examination & test: one week

2. Pre-treatment & T-Cell Collection: one week

3. T-Cell preparation & return: two-three weeks

4. 1st Effectiveness analysis: three weeks

5. 2nd Effectiveness analysis: three weeks.

Cost of CART T-Cell therapy

Total cost of CAR T-cell therapy can be anything between $ 400,000 to 7,00,000 USD in USA. However, there are centres in Asia which are doing the same treatment in $85000 – 95000 USD. Clincal trials in Tata Memoral Hospital, Mumbai, India has began for some types of blood cancer and this may bring down the cost up to $ 30,000-35000 USD.

CAR T-Cell therapy in India

At present CAR T-Cell therapy is not available in India. However it is available in China. Cost in China can be between $65000 – 85000 USD. 

Please connect with +91 97141 52285 or write to info@cancerfax.com for details on CAR T-Cell therapy treatment.
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