CAR T-Cell therapy in Singapore

 

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Table of Contents

CAR T-Cell therapy in Singapore – Current status

 

CAR-T cell therapy has become a game-changer in the way cancer is treated, and Singapore is very excited about this new therapy. Singapore has made a lot of progress in adopting CAR-T cell therapy through clinical trials, partnerships, and regulatory support. This has helped patients and contributed to improvements in cancer care. Singapore is still at the top of CAR-T cell therapy, because they keep doing research and have a good healthcare system. CAR T-Cell therapy in Singapore has gained pace giving cancer patients and their families hope.

With number of clinical trials happening at National University Hospital, Singapore, Chimeric Agent Receptor (CAR) T-Cell therapy is developing at a very fast pace in Singapore. Oscar Saxelby-Lee suffers from acute lymphoblastic leukaemia, a disease that has resisted all treatments. The five-year-old from the United Kingdom is in Singapore for a procedure that has never been given to one other infant on the planet. The boy flew in from Worcester, England, for a new type of therapy that involves drawing immune cells from a patient’s blood and implanting them with a Chimeric Antigen Receptor (CAR-T).

CAR T Cell therapy in NUH Singapore

Image: CAR T-Cell therapy trials conducted at National University Hospital, Singapore 

Singapore Health Sciences Authority (HSA) has approved Kymriah (tisagenlecleucel) as the first commercial chimeric antigen receptor T-cell (CAR-T) therapy in Singapore under the new cell, tissue and gene therapy products (CTGTP) regulatory framework. HSA approved Kymriah for the treatment of pediatric and young adult patients from 2 to 25 years of age with B-cell acute lymphoblastic leukemia (ALL) that is refractory, in relapse post-transplant or in second or later relapse; and for the treatment of adult patients with relapsed or refractory (r/r) diffuse large B-cell lymphoma (DLBCL) after two or more lines of systemic therapy. 

The receptor binds to a certain protein on cancer cells, causing CAR-T cells to activate and destroy the cancer cells. Since the leukaemia cells mimic Oscar’s immune system, this form of CAR-T therapy is unique and more complex, according to Associate Professor Allen Yeoh, head of paediatric oncology at the National University Hospital (NUH). Oscar will be the world’s second human to undergo this procedure. The first child was treated at NUH just a few year back.

CAR-T cell therapy is a new type of medicine that has changed the way people all over the world treat cancer. Singapore, which is known for its high-tech healthcare system and research infrastructure, was one of the first places to accept and use CAR-T cell therapy. In this piece, we’ll talk about where CAR-T cell therapy is right now in Singapore and how it affects cancer patients.

Singapore has medical facilities and study centres that are among the best in the world. These places have been very important to the progress of CAR-T cell therapy. Institutions like the National Cancer Centre Singapore (NCCS), the National University Cancer Institute Singapore (NCIS), and the Singapore General Hospital (SGH) have been heavily involved in clinical trials, research studies, and giving CAR-T cell therapy to patients.

Through different clinical studies, CAR-T cell therapy has made a lot of progress in Singapore. Different kinds of cancer, like leukaemia, lymphoma, and solid tumours, have been the focus of these studies. The results have been encouraging, showing a high rate of response and longer times of remission. The good results have made it possible for regulators to approve CAR-T cell treatment, which means it can now be used in clinical practise.

CAR-T cell treatment will be widely used only if it is easy to get and doesn’t cost too much. Singapore has taken steps to make sure that people can get this new treatment. Together with health care institutions, the Ministry of Health has worked on creating guidelines and reimbursement systems to make it easier for patients to get CAR-T cell therapy.

Singapore’s healthcare ecosystem puts a lot of emphasis on collaboration between healthcare workers, academics, and businesses. Singapore has been able to take part in international CAR-T cell therapy studies thanks to partnerships with the world’s top biopharmaceutical companies. These kinds of agreements have sped up research, made treatments more effective, and given more people access to cutting-edge therapies.

CAR-T cell treatment in Singapore looks like it will have a bright future. Ongoing study is focused on making CAR-T cell therapy more effective and safe, reducing the side effects of treatment, and finding ways to use it for a wider range of cancers. Singapore is a centre for CAR-T cell therapy innovation because it is committed to research and development and has a good legal environment.

Why choose Singapore for CAR T-Cell therapy?

Advanced medical infrastructure in Singapore

Advanced medical infrastructure


Singapore is known for its cutting-edge technology and world-class medical facilities. The government has put a lot of money into healthcare and has a system that is strong and up to international standards. In 2010, the WHO put Singapore’s health care system sixth out of the 100 best in the world. At the moment, 22 hospitals and other medical facilities in Singapore have been approved by Joint Commission International (JCI). In general, you can get any kind of medical care you might need in Singapore at a fair price and with good service.

Skilled medical professionals in Singapore

Highly skilled medical professionals


Singapore has a lot of highly skilled and experienced doctors, including oncologists and haematologists who specialise in CAR-T cell treatment. These specialists have been trained in the U.S. and abroad, and many of them have worked or studied in well-known medical institutions abroad. Singapore has a lot of successful treatments and happy patients because of the skills of these experts. Most of these medical professionals are involved in research activities and thus exposing themselves to latest drugs and treatment in the field of cancer treatment. 


Regulations and quality control in Singapore

Strict regulations and quality control


The health care business in Singapore is controlled by strict rules and quality checks. Health officials in the country, like the Health Sciences Authority (HSA), make sure that medical treatments, like CAR-T cell therapy, meet strict standards for safety and effectiveness. This gives foreign patients who want to get treatment in Singapore peace of mind because they know they will get good care.

 

multicultural diversity in singapore

Multicultural and English speaking environment


Singapore is a city with a lot of different cultures and people, and English is one of its recognised languages. This makes it a good place for foreign patients to go because communication is easy and quick. Patients from other countries can easily talk to their doctors, learn their treatment options, and have their medical concerns taken care of. Patients from many different countries feel welcome because of the different cultures.

 

How to apply for CAR T-Cell therapy in Singapore?

Send your medical reports to info@cancerfax.com or WhatsApp them to (+1-213 789-56-55). Send following reports for opinion and estimate:

1) Medical summary

2) Latest blood reports

3) Biopsy

4) Latest PET Scan

5) Bone marrow biopsy (If available)

6) Any other relevant reports and scans

Once our team receives your medical reports, we analyze them and send it to hospitals that are performing CAR T-Cell therapy with that type of cancer and marker. We send reports to the concerned specialist and get his opinion. We also get estimate from the hospital on complete treatment. This helps you in planning for the entire treatment duration. 

Once you decide to visit for the treatment, we arrange for medical visa letter and other necessary documents from the hospital. We get your medical visa within 72 hours of filling the visa form 14(A). Once visa is ready we help and guide you in preparing for travel and flight tickets. We also arrange for your hotel and guest house, if required in Singapore. Upon arrival in the city of treatment our representative will welcome you at the airport.

Our representative will arrange for doctor appointment and complete the necessary registration formalities for you. He will also help you with your hospital admission and other local help and support that are required. After the treatment is over we will arrange for your follow up consultation with the treating doctor.

Top hospitals for CAR T-Cell therapy in Singapore

CAR T Cell therapy hospital in Singapore Parkway

Parkway Cancer Center


The innovative immunotherapy method known as CAR T-cell therapy has showed exceptional promise in the treatment of a variety of malignancies. Beijing, China’s Peking University Cancer Hospital has become a global leader in the development of CAR T-cell treatment. With the help of their multidisciplinary team, which consists of oncologists, immunologists, and geneticists, personalized cancer treatment has advanced significantly. Peking University Cancer Hospital has obtained outstanding outcomes in patients with haematological malignancies by altering patients’ own T cells to express chimeric antigen receptors (CARs). This cutting-edge treatment gives cancer patients fresh hope while revolutionizing the field of oncology and raising survival rates.

Website

National Univercity cancer institute singapore

National University Cancer Institute, Singapore


The National University Cancer Institute (NCIS) in Singapore is a well-known place that works to avoid, diagnose, and treat cancer. As a part of the National University Health System, NCIS gives people with cancer full and coordinated care. The institute brings together clinical expertise, cutting-edge research, and education to come up with personalised treatment plans that are based on scientific proof. The NCIS has state-of-the-art tools, such as advanced imaging technology and equipment for radiation therapy. Its multidisciplinary method brings together experts from different fields to make treatment plans that are just right for each patient. With a focus on translational research, NCIS wants to learn more about cancer and make it better for patients through new therapies and clinical studies.

Website

CAR T-Cell therapy specialists in Singapore

Take expert second opinion on CAR T-Cell therapy infusion from best specialists in Singapore. 

Dr Ang Peng Tiam best oncologist in Singapore

Dr. Ang Peng Tiam (MD, MRCP, FAMS, FACP)

Medical oncology

Profile: Medical Director and senior consultant at Parkway cancer center in the oncology division. Dr Ang is a council member of Singapore Cancer Society. He was also the past President of Singapore Society of Oncology..

Dr Colin Phipps Diong CAR T Cell therapy specialist in Singapore

Dr. Diong Colin Phipps (MBBS, MRCP, FRCP, CCT)

Hematology

Profile: Dr Colin received his medical degree from the National University of Ireland in 2002 and subsequently completed Internal Medicine residency and specialist training in Haematology at Singapore General Hospital. 

Teo-Cheng-Peng car t cell therapy specialist in singapore

Dr Teo Cheng Peng (MD, FAMS)

Hematology

Profile: Dr. Teo Cheng Peng is Senior Consultant, Haematologist at Parkway Cancer Centre. He obtained advanced training in Stem Cell Transplant & Haematological Malignancies at the prestigious Royal Marsden Hospital (United Kingdom).

What is CAR T-Cell therapy?

 

CAR-T-Cell- therapy in China

Chimeric antigen receptor T-cell therapy, often known as CAR T-cell therapy, is a ground-breaking immunotherapy that has completely changed the way that cancer is treated. It gives patients with certain cancers hope that were previously seen as incurable or with few therapeutic alternatives.

The treatment entails using a patient’s own immune cells—more specifically, T cells—and lab-modifying them to improve their capacity to detect and destroy cancer cells. To do this, the T cells are given a chimeric antigen receptor (CAR), which gives them the ability to target particular proteins, or antigens, on the surface of cancer cells.

T cells from the patient are first removed, and they are then genetically modified to express the CAR. In the laboratory, these altered cells are multiplied to produce a sizable population of CAR T cells, which are then put back into the patient’s bloodstream.

How it works CAR T Cell therapy in China

As soon as they are inside the body, CAR T cells find cancer cells that express the desired antigen, attach to them, and trigger a potent immune response. The CAR T cells that have been activated proliferate and conduct a focused attack on the cancer cells, killing them.

How does CAR T-Cell therapy works?

 

 

How CAR T Cell therapy works in Singapore

When used to treat some blood malignancies like acute lymphoblastic leukaemia (ALL) and specific forms of lymphoma, CAR T-cell therapy has shown exceptional results. It has produced notable response rates and in some patients, even long-lasting remissions.

CAR T-cell therapy, however, is a sophisticated and unique therapeutic method that might have risks and adverse effects. Cytokine release syndrome (CRS), a widespread immunological reaction that can result in flu-like symptoms and, in extreme situations, organ failure, may be experienced by certain people. There have also been reports of neurological adverse effects, however they are frequently curable.

Despite these difficulties, CAR T-cell therapy is a significant advancement in the fight against cancer and shows great potential for the future. Current studies are focused on enhancing its efficacy and safety profile as well as extending its uses to different cancer types. CAR T-cell therapy has the ability to change the face of cancer treatment and give patients everywhere new hope with further advancements.

This type of therapy involves modifying the patient’s T cells, an immune cell type, in the lab so they will bind to and kill cancer cells. A tube transports blood from a vein in the patient’s arm to an apheresis device (not shown), which extracts white blood cells, including T cells, and returns the remaining blood to the patient.
 
The T cells are then genetically modified in the lab to contain the gene for a unique receptor known as a chimeric antigen receptor (CAR). The CAR T cells are multiplied in a lab before being infused into the patient in large numbers. The antigen on the cancer cells can be recognized by CAR T cells, which then kill the cancer cells.
 

Procedure

The CAR-T therapy procedure, which takes a few weeks, involves multiple steps:

T cells are extracted from your blood using a tube that is placed into an arm vein. This takes a couple of hours.

T cells are transported to a facility where they undergo genetic modification to become CAR-T cells. Two to three weeks pass throughout this.

CAR-T cells are reintroduced into your bloodstream through a drip. This requires several hours.

CAR-T cells target and eliminate cancer cells throughout the body. After receiving CAR-T therapy, you will be closely watched.

What type of cancer cells can be treated with CAR-T Cell Therapy? 

Only patients with adult B-cell non-lymphoma Hodgkin’s or pediatric acute lymphoblastic leukemia who have already tried two unsuccessful conventional therapies can currently use CAR T-cell therapy products that have received FDA approval. However, CAR T-cell therapy is now being tested in clinical studies as a first or second-line treatment for adult lymphoma and pediatric acute lymphoblastic leukemia. Recently, some of the studies have shown remarkable successes in cases of solid tumors too like glioblastoma, gliomas, liver cancer, lung cancer, GI cancer, pancreatic cancer and oral cancers.

To conclude

This represents a significant advancement in the management of leukemia and B-cell lymphoma. Additionally, it gives hope to those whose lives had previously been predicted to last only six months. Now that we have identified mechanisms of resistance and created more techniques to combat them, the future appears to be much more promising.

Get in touch with our highly experienced healthcare providers here at CancerFax for a free consultation to work out a suitable care plan for your healthcare needs. Please send your medical reports to info@cancerfax.com or WhatsApp to +1 213 789 56 55.

What are the advantages of CAR-T Cell Therapy?

The main benefit is that CAR T-cell therapy only requires a single infusion and often only requires two weeks of inpatient care. Patients with non-Hodgkin lymphoma and pediatric leukemia who have just been diagnosed, on the other hand, typically need chemotherapy for at least six months or more.

The advantages of CAR T-cell therapy, which is actually a living medication, can persist for many years. If and when a relapse occurs, the cells will still be able to identify and target cancer cells because they can survive in the body for an extended period of time. 

Although the information is still developing, 42% of adult lymphoma patients who underwent CD19 CAR T-cell treatment were still in remission after 15 months. And after six months, two-thirds of patients with pediatric acute lymphoblastic leukemia were still in remission. Unfortunately, these patients had exceedingly aggressive tumors that weren’t successfully treated using traditional standards of care.

What type of patients would be good recipients of the CAR-T Cell Therapy?

Patients between the age of 3 Years to 70 Years have been tried with CAR T-Cell therapy for different type of blood cancers and has been found to be very effective. Many centers have claimed success rates of more than 80%. The optimum candidate for CAR T-cell therapy at this time is a juvenile with acute lymphoblastic leukemia or an adult with severe B-cell lymphoma who has already had two lines of ineffective therapy. 

Before the end of 2017, there was no accepted standard of care for patients who had already gone through two lines of therapy without experiencing remission. The only FDA-approved treatment that has so far proven to be significantly beneficial for these patients is CAR T-cell therapy.

How effective is CAR-T Cell therapy?

CAR T-cell therapy has been very effective in treating some types of blood cancer, like acute lymphoblastic leukaemia (ALL) and non-Hodgkin lymphoma. In clinical trials, the response rates have been very good, and a lot of patients have gone into full remission. In some cases, people who had tried every other medicine had long-lasting remissions or even possible cures.

One of the best things about CAR T-cell treatment is that it targets the right cells. The CAR receptors that have been added to the T cells can find specific marks on cancer cells. This makes it possible to give targeted treatment. This targeted method hurts healthy cells as little as possible and lowers the risk of side effects that come with traditional treatments like chemotherapy.

But it’s important to keep in mind that CAR T-cell therapy is still a new area that is still changing. Researchers and doctors are working hard to solve problems like the high cost, the possibility of serious side effects, and the fact that it only works for some types of cancer.

In the end, CAR T-cell therapy has shown to be a very successful way to treat some types of blood cancer. Even though it is a promising and powerful method, more study and clinical trials are needed to improve it and find new ways to use it. CAR T-cell therapy could change how cancer is treated and make things better for people all over the world if it keeps getting better.

Inclusion & exclusion criteria

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.

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.

CAR T-Cell therapies approved by USFDA

B-cell precursor acute lymphoblastic leukemia, relapsed or refractory diffuse large B-cell lymphoma

Complete response rate (CR): >90%

Target: CD19

Price: $475,000

Approval time: August 30, 2017

Relapsed or refractory diffuse large B-cell lymphoma, relapsed or refractory follicular cell lymphoma

Non-Hodgkin’s lymphoma Complete response rate (CR): 51%

Target: CD19

Price: $373,000

Approval time: 2017 October 18

Relapsed or refractory diffuse large B-cell lymphoma

Mantle cell lymphoma Complete response rate (CR): 67%

Target: CD19

Price: $373,000

Approved time: October 18, 2017

Relapsed or refractory diffuse large B-cell lymphoma

Complete response rate (CR): 54%

Target: CD19
Price: $410,300

Approved time: October 18, 2017

Relapsed or Refractory Multiple Myeloma 

Complete response rate: 28%

Target: CD19
Price: $419,500
Approved: October 18, 2017

What are the side effects of CAR-T Cell therapy?

Below mentioned are some of the side-effects of CAR T-Cell therapy.

  1. Cytokine release syndrome (CRS): The most prevalent and possibly significant side effect of CAR T-cell treatment is cytokine release syndrome (CRS). The flu-like symptoms, including fever, exhaustion, headaches, and muscle pain, are brought on by the modified T cells’ production of cytokines. In extreme circumstances, CRS may result in a high temperature, hypotension, organ failure, and even potentially fatal consequences. 
  2. Neurological Toxicity: Some patients may develop neurological side effects, which can range in severity from less serious signs like mild confusion and disorientation to more serious ones like seizures, delirium, and encephalopathy. After CAR T-cell infusion, neurological toxicity frequently happens during the first week. 
  3. Cytopenias: CAR T-cell treatment can result in low blood cell counts, such as anaemia (low red blood cell count), neutropenia (low white blood cell count), and thrombocytopenia (low platelet count). Infections, bleeding, and exhaustion are among risks that can be exacerbated by these cytopenias. 
  4. Infections: The CAR T-cell therapy’s suppression of healthy immune cells increases the risk of bacterial, viral, and fungal infections. In order to prevent infections, patients may need to be closely watched and given preventive medication.
  5. Tumour Lysis Syndrome (TLS): After CAR T-cell therapy, it’s possible in some circumstances for substantial amounts of cell contents to be released into the bloodstream due to the rapid killing of tumour cells. This may result in metabolic abnormalities, such as excessive potassium, uric acid, and phosphate levels, which may damage the kidneys and cause other problems. 
  6. Hypogammaglobulinemia: CAR T-cell treatment has the potential to decrease antibody synthesis, which could result in hypogammaglobulinemia. This might make recurrent infections more likely and call for continuing antibody replacement medication. 
  7. Organ Toxicity: CAR T-cell therapy has the potential to harm a number of organs, including the heart, lungs, liver, and kidneys. This may lead to abnormal renal function tests, respiratory issues, heart issues, and abnormal liver function tests.
  8. Hemophagocytic lymphohistiocytosis (HLH): A rare but possibly fatal immunological disease called hemophagocytic lymphohistiocytosis (HLH) can develop as a result of CAR T-cell therapy. It involves the overactivation of immune cells, which causes serious organ damage and inflammation.
  9. Hypotension and Fluid Retention: As a result of the cytokines that CAR T cells release, some patients may develop low blood pressure (hypotension) and fluid retention. To address these symptoms, supportive measures including intravenous fluids and drugs could be required.
  10. Secondary Malignancies: Reports of secondary malignancies emerging following CAR T-cell therapy exist, notwithstanding their rarity. Research is currently being done on the potential for secondary malignancies and long-term hazards.

It’s important to remember that not every patient will have these side effects, and that each person’s level of sensitivity will differ. In order to minimize and minimize these potential adverse effects, the medical team closely examines patients before, during, and after CAR T-cell therapy.

Time frame

Check below the total time frame required for complete the CAR T-Cell therapy process. Although time frame depends a lot on the distance of lab from the hospital that prepared the CAR’s.

  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.

Total time frame: 10-12 Weeks

Video on CAR T-cell therapy in Singapore

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