CAR T-Cell therapy in Singapore
October 2021: 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).
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 months back.
New advanced drugs, such as CAR-T (chimeric antigen receptor T-cell), are life-changing medications for people who have exhausted their possible treatment options. These cutting-edge treatments are provided in non-traditional ways, including long, complicated, and highly organized series of activities inside the healthcare provider’s facilities. Providers will benefit from these treatments in a variety of ways, from enhancing their reputation as cutting-edge organisations to providing high-profit-generating programmes. However, delivering these latest advanced treatments poses significant financial and operating challenges if not carefully assessed and prepared.
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 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 attack the specific antigen and kills the tumor cells.
How does CAR T-Cell therapy work?
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.
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, Myeloma 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.
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
Advantages of CAR T-Cell therapy
- >5000 CAR T cases done by highly skilled doctor’s.
- Hospitals in China has developed more CAR T Cell types including CD19 & CD 22 then any other country in the world.
- China is conducting more than 300 clinical trials on CAR T Cell therapy. More than any other country on the planet.
- Clinical effect of CAR T Cell is similar to that in USA or any other country and sometimes better.
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 CAR T-Cell therapy in Singapore
Cost of CAR T-Cell therapy in Singapore will be approximately between $ 450,000 – 500,000 USD. For details on eligibility criteria and cost estimate please send your medical reports to info@cancerfax.com with your name and age as subject.
Also read this : CAR T Cell therapy in India
Side effects of CAR T-Cell therapy
The common side effects of CAR T-cell therapy include:
- Cytokine release syndrome
In some cases, patients may develop flu-like symptoms such as fever, chills, headache, nausea, vomiting, loose stools, and muscle or joint pains. It may also cause low blood pressure, difficulty in breathing, and a fast heart rate. These side effects are due to the release of cytokines by the immune cells during CAR T-cell therapy. These symptoms are usually mild, but can be serious and life threatening in some patients. - Neurological events
Neurological events can occur and can be serious in some patients. Such events include encephalopathy (brain injury and malfunction), confusion, difficulty speaking, agitation, seizures, drowsiness, altered state of consciousness and loss of balance. - Neutropaenia and Anaemia
Some patients may develop neutropenia or low white cell count. Similarly, anaemia or low red blood cell count may also occur due to this therapy.
Fortunately, most of these side effects usually resolve on their own or can be managed with the use of medications.
How effective is CAR T-Cell therapy ?
CAR T-cell therapy for the treatment of lymphoma and other blood cancers has shown promising outcomes. Since CAR T-cell treatment, many patients who had previously relapsed blood tumours had promising results and no evidence of cancer. It has also aided in the rehabilitation of patients who have previously failed to respond to most traditional cancer therapies.
However, longer-term studies for a larger patient population are needed to validate the efficacy of this treatment. Large-scale experiments would also aid in determining the likelihood of side effects and the right ways to deal with them.
Image: Parkway Cancer Centre, Mount Elizabeth Hospital is among the first hospital’s in Singapore to use CAR T-Cell therapy
Benefits of treatment in Singapore
Singapore is totally a different country in its region in practically every way, from infrastructure to healthcare, and it ranks first in almost all of these indices. Singapore is no exception in this regard, as the country sits unmatched at the top of the sector in its region and is also one of the most appealing medical tourism destinations in the world. It’s all the more astounding when you consider that Singapore accomplished this achievement in a region that includes formidable competitors like India, Thailand and Malaysia, all of whom are aspiring medical tourism powers with their own distinct and unique selling factors.
The origins of medical tourism in Singapore date back to the 1990 recession in Southeast Asian countries, when Singapore, along with Thailand and Malaysia, began investing large sums of money in the medical tourism industry to make up for the deficit caused by the economic crisis. Due to Singapore’s status as the most developed country in its region, as well as its world-class medical quality, it quickly leapfrogged its regional competitors.
Key factors of medical tourism in Singapore
- Singapore is one of the world’s top medical tourism destinations. According to the Medical Tourism Association, Singapore ranks second after Canada in the Medical Tourism Index.
- The city-state receives approximately 500,000 medical tourists each year. As many as 250,000 medical tourists come from Indonesia alone.
- Singapore’s private hospitals offer exceptional healthcare services with state-of-the-art facilities and well-trained medical specialists.
- International medical tourists visit Singapore each year for a whole range of medical care and treatments from health screenings to surgery.
- Medical tourists can cover healthcare costs by obtaining an international health insurance plan.
Top hospitals in Singapore
- Mount Elizabeth Hospital
- National University Hospital
- Raffles Hospital
- National Cancer Centre
- National Heart Centre Singapore
- Singapore National Eye Centre
- National Dental Centre
- Singapore General Hospital
- Changi General Hospital
- Gleneagles Hospital
- National Skin Centre
- Johns Hopkins Singapore International Medical Centre
- Tan Tock Seng Hospital
