The death of actor Rahul Koli, who played a significant role in India’s Oscar-nominated film Chhello Show (The Last Film Show), from leukemia at age 17, has shed light on the status of the dreaded blood cancer among young people in the country.
Rahul was diagnosed with leukaemia — the cancer of the body’s blood-forming tissues — this year. He was initially treated at a Jamnagar hospital. After remaining in the hospital for two weeks, he was admitted to the Ahmedabad cancer hospital four months ago.
So what’s the status of leukaemia in India? “In India, around 60,000 to 70,000 children (though under-reporting is a major concern) every year (between the 1 and 18 age group) are being diagnosed with Acute Myeloid Leukaemia (AML) or Acute Lymphocytic Leukemia (ALL). AML starts in the bone marrow (the soft inner part of bones where new blood cells are made), but quickly moves into the blood and other parts of the body, including the lymph nodes, liver, spleen and central nervous system (brain and spinal cord). ALL progresses rapidly and creates immature blood cells. It affects the white blood cells called lymphocytes. There was a time when identification and diagnosis would be delayed in India but now the increase in numbers is reflective of the fact that increased awareness among primary care physicians and paediatricians are hastening targetted treatment. Besides, there is a better mechanism to collate data of all paediatric oncology groups which helps in research and finding effective treatment protocols,” says Dr Gaurav Kharya, paediatric oncologist at Indraprastha Apollo Hospitals, New Delhi. “In fact, 70 per cent of paediatric cancer cases in India are AML with 30 per cent being ALL,” he adds.
So what’s the success rate of therapies? “Timely intervention is the key. So while the recovery rate for AML is 60 to 70 per cent, for ALL, it is 90 per cent if they are treated in a disciplined way with targetted drugs. Now these are more precise, less toxic and with immunotherapies and transplant, survival rates can go up higher,” says Dr Kharya.
He has great expectations of the CAR T-cell therapy, which is being used globally. This involves extraction of T-cells from a cancer patient’s body. Then a virus, which is a modified and inactivated version of the HIV virus but doesn’t cause HIV, is used to deliver genes into the T-cells. These genes then weaponise the T-cells to attack cancerous cells. In other words, the T-cells are removed from the body, placed in an extremely sterile laboratory, are activated with gene therapy and harvested in incubators until they expand to a very large number and are frozen. This process usually takes about 10 to 14 days before the cultured cells are transfused back into patients. This has helped patients who were on the verge of death and mostly had liquid cancers or leukemias as their tumours had stopped responding to multiple cycles of chemotherapy.
Now Dr Siddhartha Mukherjee, an eminent oncologist and Pulitzer award-winning author, is rolling out a significant clinical trial on CAR T-cell therapy in India. During an Idea Exchange at the Indian Express, he had said, “We also tried to ensure that the activated T-cells, which release cytokines or chemicals that T cells use to communicate with each other and with the immune system, wouldn’t generate a cytokine storm. We controlled it with medicines. Since then, we’ve already dosed several patients. A group in IIT Mumbai with Tata is also dosing patients using the same formula. Theirs is a phase one trial, ours is a phase two trial. Theirs is a new product, ours is a clinically exposed product that has already been proven to be successful in humans. The effectiveness of CAR-T therapy in children has been 90 per cent. In other words, five to seven years of survival in 80 to 90 per cent of patients. And remember, these patients were initially refractory or relapsed. It was a very difficult population to treat, the only other treatment available to them being a bone marrow transplant.”
Dr Kharya himself is also working with Cellogen Therapeutics to develop a third and fourth generation CAR T-cell therapy indigenously. “We have done our in-vitro validation which looks very promising. Our pre-clinical work is in progress subsequent to which we intend to start out phase one of clinical trials very soon. Once available this will be the first indigenous third generation gen CAR-T constructs available in the country for clinical use,” he adds.