Cancer at advanced stage can also be cured

Raju Vernekar
In a breakthrough in research, Indian Institute of Technology (IIT)-Bombay scientists have developed technology to leverage a patient’s immune system to cure cancer, using CAR T cells, which can be made available for Rs 15 lakh, if the technology is developed in India.
Newly-patented indigenous CAR-T cell technology puts cancer treatment within reach for patients in India. While a treatment for cancer with such immunotherapy using CAR T-cells, costs Rs 3-4 crore in US, it can be made available for Rs 15 lakh, if the technology is developed within the country.
The researchers-Prof Rahul Purwar and his team, are now planning to submit an application to the Drug Controller General of India (DCGI) for regulatory approvals and are in the process of initiating clinical trials at the Tata Memorial Hospital, Mumbai. ‘‘We expect to start trials by mid or late 2020 depending on the DCGI approvals,’’ Purwar said and added that the product would be available in the market in approximately two years.
At present a private firm is planning to in-licence the technology and is trying to make the therapy available for Indian patients for about Rs 35 lakh. Purwar and two researchers are working on the technology as part of their start-up ImmunoAdaptive Cell Therapy or ImmunoACT, which was incubated at IIT-Bombay.
Purwar and his team of scientists from IIT’s Department of Biosciences and Bioengineering  used a combination of gene therapy and cell therapy to modify the immune cells to attack and kill cancer cells and conducted laboratory tests and hope to start clinical trials in collaboration with Dr Gaurav Narula from Tata Memorial Hospital (TMH), Mumbai next year, after getting permission from DCGI. A facility has already been created for it at the TMH’s  Kharghar campus in Navi Mumbai.
The researchers who have been working on CAR T-cell technology for the last six years, collaborated with the National Cancer Institute and established a short-term scientist exchange program. The team delved into strategies that would improve the efficacy of this technique and demonstrated that a single injected dose would lead to multiplication of modified T-cells that can destroy cancer cells. They tested it on artificially grown cancer cells and carried out several quality checks to ensure the long-term safety of the treatment. 
 ”It is an autologous cell therapy for personalised medicine, where cells are taken from patients, re-engineered and re-infused in the patient. We got immune cells from volunteers and clinical patients with help from TMH and re-engineered them using the technique. The modified cells were positively tested in laboratories on artificially grown cancer cells,” Purwar said.
Researchers made use of gene and cell therapies to re-engineer immune cells to attack and kill cancer cells in the body. The treatment is less painful than surgery, chemotherapy or radiation, and is known to lower chances of a relapse. The therapy, which seems promising in the treatment of cancer, especially leukaemia, is currently not available in India. With the growing burden of cancer in the country, success in even a fraction of the patients using the technique will be remarkable.
T-cells (type of white blood cell or WBC), an integral part of the human immune system, protect our body from cancer and other diseases. They can identify tumours and destroy them. But in advanced stages, the cancer cells adapt to the presence of T-cells and remain undetected. In the new approach in immunotherapy, called CAR (chimeric antigen receptors) T-cell therapy, the T-cell’s ability to detect and kill cancer cells is restored. CARs are protein that assist T-cells to recognise and attach to protein or antigen, present on cancer cells. These proteins help destroy cancer cells.
The CAR T-cells are popularly called ‘living drugs’ since they stay in the body forever. They are engineered from the patient’s T-cells. The therapy involves drawing blood from a patient and separating the T-cells, which are then genetically engineered with the help of a non-pathogenic virus, to produce CARs. The cells, which can now recognise the antigen on cancer cells and destroy them, are then reintroduced into the patient’s bloodstream.
Globally, over 600 clinical trials are in progress for CAR T-cell therapy, many of which are on in China, Dr Narula said and added that “It has got huge potential. Technologies are being developed globally, but are exorbitant. The only way to cut costs is by developing the technology in India, which is why we teamed up with IIT-B, long before the first therapy was approved for clinical use in US. There are high expectations from this technology as it can create pathways for developing newer technologies, for newer therapies, for more forms of cancer.
First presented in 2017, the CAR T-cell technology looks very promising for the treatment of cancers, especially leukaemia. For now, this therapy is not available in India, and costs crores of rupees abroad.
(Author is Mumbai based senior journalist)