Cancer therapy gets cheaper and effective: CAR T-cells developed in hospital, patients in remission

What were the study findings?

Altogether 10 patients, aged between 6 and 59, were selected after other treatments failed to improve their condition. Six of them had acute leukemia and four had lymphoma. They were treated with CAR T-cells developed at CMC Vellore over nine days as part of a point-of-care (PoC) strategy.

The study found that the therapy brought about 100 per cent remission in acute lymphoblastic leukaemia patients and 50 per cent remission in large B-cell lymphoma patients. “Overall, eight of the ten patients remained cancer-free at a median follow-up of 15 months. The therapy was safe, well-tolerated and had minimal side effects,” says Dr Mathews. If successful in Phase II trials across multiple centres, this model can be replicated in tertiary hospitals across the country.

How was the therapy developed?

Dr Mathews explains that chimeric antigen receptor T-cells (CAR T-cells) are normal T-cells that are part of the patient’s own immune system. “This process usually involves inserting the required genetic information into normal T-cells to produce an antibody receptor that will recognise the antigen/substance on the surface of the cancer cell. This is usually done in large centralised commercial corporations, which contributes to logistic challenges, increased costs, and decreased efficacy,” he says.

But produced at the hospital site itself, this could be effective at a lower cost. “Just imagine if 100 centres could manufacture CAR T-cells at the hospital. Wouldn’t it significantly bring down cost in the long run?” he asked.

Why is the trial significant?

Access to CAR T-cell therapy is limited by cost and turnaround time, even in developed countries. The current centralized model with industry-driven CAR T- cell manufacturing is not viable to the requirements and realities of developing countries like India. Researchers, however, have provided evidence that this is feasible in India.

“The early data from this study establishes its safety and also shows promising results,” says Dr Mathews.

Redefining cancer therapies

Dr Mathews says researchers used fresh, unfrozen CAR T-cells, which resulted in better outcomes. Unfrozen CAR T-cells are infused directly into the patient after the modification and expansion process, bypassing the freezing step. This approach aims to preserve the cells’ fresh, robust state, potentially leading to better anti-tumour activity. This also means that infusion can occur sooner after the cell modification process, potentially shortening the treatment timeline.

“Our trial redefines how cancer therapy can be delivered — efficiently, affordably and close to patients. India is leading the way in developing next-generation, in-house biotherapies with global relevance,” Dr Mathews says.

The study, titled “Safety, efficacy and total cost of point-of-care manufactured anti-CD19 CAR-T cell therapy in India: VELCART trial”, has been published in the journal Molecular Therapy.