India witnessed a significant cancer burden in 2022, with over 14.13 lakh new cases and 9.16 lakh deaths reported, as per the latest World Health Organisation estimates. Despite this alarming trend, a ray of hope shines through.
Recently, an indigenous treatment, which reprograms a patient’s immune system to combat cancer, received commercial approval from the Central Drugs Standard Control Organisation (CDSCO).
The breakthrough was spearheaded by an Indian researcher and her team, who ingeniously modified the Chimeric Antigen Receptor (CAR) T-cell, customizing it to address the specific needs and challenges of cancer treatment in India.
The genesis of this innovation traces back to 2015 when Alka Dwivedi, during her tenure at IIT Mumbai’s Department of Biosciences and Bioengineering, delved into comprehending the intricacies of Haematological malignancies, commonly known as blood cancer, as part of her doctoral research.
Motivated by the dual concerns of the escalating cancer prevalence in India and the exorbitant costs associated with CAR-T cell therapy in the United States, Dr. Alka Dwivedi embarked on a mission to develop an affordable solution.
CAR-T cell therapy, a form of immunotherapy, entails modifying the patient’s T cells to target and eliminate cancer cells. The acronym CAR stands for chimeric antigen receptor.
Dr. Dwivedi elucidated that the term “chimeric” signifies the fusion of multiple proteins, a crucial step in enhancing the efficacy of the therapy.
The painstaking process involves extracting T cells from the patient’s bloodstream, engineering them to recognize and destroy cancer cells, and subsequently reintroducing them into the patient’s system to unleash their anti-cancer prowess.
After a decade-long journey marked by rigorous laboratory tests, pre-clinical and clinical trials, the researchers succeeded in developing Actalycabtagene Autoleucel, now christened ‘NexCar19’, India’s very own version of CAR-T cell therapy.
However, the path to this milestone was fraught with challenges. Dr. Dwivedi and her team encountered setbacks initially, particularly in refining CAR-T cells to mimic human antibodies more accurately. Through collaboration with researchers at the National Cancer Institute, they overcame these obstacles and achieved promising results in both laboratory and animal studies.
Subsequently, NexCAR19 obtained commercial approval, offering renewed hope to cancer patients across the nation. Dr. (Col) VK Gupta, a Delhi-based gastroenterologist, became the first recipient of this groundbreaking treatment and attained a cancer-free status post-treatment. The cost of this transformative therapy stands at Rs 40 lakh.
NexCAR19 primarily targets CD19, a protein prevalent on the surface of leukaemia and lymphoma cells, thus presenting a viable treatment option for patients afflicted with these conditions.
While NexCAR19 shares similarities with CAR-T therapies in the United States, it distinguishes itself by incorporating human proteins into its mouse antibodies, thereby enhancing effectiveness while mitigating adverse cytokine reactions.
The staggering cancer burden in India underscores the urgency for innovative treatments. Dr. Dwivedi’s passion for addressing this challenge was evident from the inception of her academic journey.
ImmunoAct, a spin-off company of IIT Mumbai, which funded the trial of NexCAR19, will oversee its manufacturing and distribution.
Looking ahead, Dr. Dwivedi remains committed to refining NexCAR19 and making it more accessible. She envisions developing an allogeneic CAR-T cell therapy, wherein CAR-T cells derived from healthy donors are banked, offering a cost-effective and scalable solution for cancer treatment in India.
With each breakthrough, the promise of a brighter future for cancer patients in India becomes increasingly tangible.