Cancer therapy has undergone tremendous advances in the last few years. Immunotherapy or directing the body’s immune system to target cancer cells and sparing or having only minimum effects on other organs, has revolutionized the treatment of cancer. Checkpoint inhibition is one such strategy, which has been effectively used to treat some lymphomas and many solid cancers. Another approach is the use of living cells to target and kill cancer cells, called cellular therapy. An older version of cellular therapy is bone marrow transplant or stem cell transplant, used for many years now, to treat blood cancers and some solid tumors.

Chimeric antigen receptor (CAR) T-cell therapy, which utilizes the patient’s living T- lymphocytes or “living drugs”, has marked a new era in the treatment of cancer. Emily Whitehead, a 6-year-old girl, was the first pediatric patient to receive CAR T-cells in 2012 at the University of Pennsylvania for refractory acute lymphoblastic leukemia (ALL). She was cured of her cancer, which garnered a lot of attention to CAR T-cells. CAR T-cell therapy has been effectively used in some blood cancers such as, relapsed or resistant B cell Acute Lymphoblastic Leukemia (ALL), multiply relapsed Myeloma and relapsed/refractory B cell Lymphomas.

In CAR T-cell therapy, the T cells undergo genetic re-engineering so that they can attack specific proteins on the surface of cancer cells and kill them. The T cells are obtained from the WBCs of the patient which are separated from the whole blood by leukapheresis. The viral transduction technique is used to modify the extracted T cells and enable expression of the chimeric antigen receptor on their surface. This entire process takes about 4 weeks. The cells are then infused back into the patient after prior conditioning for 3-4 days with reduced dose chemotherapy. The objective is to develop an environment in the body, which is conducive to proliferation and expansion of the CAR T-cells.

The CAR T-cells remain in the body for a long time and kill residual cancers and may even cure resistant cancers. CAR T-cell therapy has been successfully used to treat multiple myeloma, leukemias like B cell acute lymphoblastic leukemia and B cell lymphomas like diffuse large B cell lymphoma, mantle cell lymphoma, follicular lymphoma. Will CAR T-cell therapy be of help in a specific situation is a decision to be taken in consultation with the treating oncologist. In the United States, this therapy costs crores of rupees. Keeping with the spirit of the Make in India initiative, researchers at IIT Mumbai and Advanced Centre for Treatment, Research and Education in Cancer (ACTREC) at Tata Memorial Hospital in Mumbai are working to develop indigenous CAR T-cells at 1/10th of this cost. The end goal must be to make this treatment accessible and also more affordable to the majority of people; this requires development of “Institutional CAR T-cells”.

The times are just right for indigenous research and development. They have never been better.

Development of new and better treatment options will not only help patients in our country, global patients too can benefit from these innovations.