For Jharkhand based journalist Ravi Prakash, who has been battling fourth stage lung cancer for over three and a half years now, there is a glimmer of hope for a new life. After fighting the disease with intensive sessions of chemotherapy, the journalist is now undergoing a treatment called CAR T- cell therapy in Mumbai. Prakash is the sixth patient in the country to receive this treatment and is being treated by Dr Vijay Patil at Sunact Cancer Institute, Thane. In a tête-à-tête with The Pioneer, Dr Vijay Patil sheds lights on what is CAR T Cell therapy, its side effects, precautions and the cost. Q: What is CAR T- cell therapy? Is it only effective for lung cancer or other types of cancer as well? A: CAR T- cell stands for Chimeric antigen receptor therapy. Our bodies have 2 -3 types of cancer and our WBC fights these cancer cells. If our WBC is active no one will have cancer. In this therapy we activate WBC to fight cancer in the body. The patients blood is taken and a special type of WBC called Lymphocyte is extracted by the machine while the remaining blood is given back to the patient. This is then genetically modified in the lab to firstly identify cancer cells and secondly kill the infected cells. Millions of the CAR T- cells are grown in the laboratory and then given to the patient by infusion. The CAR T- cells are able to bind to an antigen on the cancer cells and kill them. It is basically a way to get immune cells called T cells (a type of white blood cell) to fight cancer by changing them in the lab so they can find and destroy cancer cells. This treatment can be effective for all types of cancer if the patients cancer cells have a unique mutation. The therapy has shown best results in types of blood cancer including leukemia, lymphoma and multiple myeloma with a success of 80- 90%. For lung cancer, breast cancer or ovarian cancer, the development has been done in the last one and a half to two years and it also depends on the stage and mutation of the disease. Q: After this therapy what precautions does the patient need to follow? A: Precautions depend on whether the treatment is Autologous or Allogeneic. In Autologous the patients blood is being used while in Allogeneic blood is taken from a person other than the patient. For a cancer patient, after undergoing CAR T cell therapy one needs to take precautions against infections. These include consuming hygienic or boiled water. The doctors advice also needs to be closely followed about the way of cooking food for the patient. Consumption of uncooked food or un- hygienically cooked food is also strictly prohibited. To further reduce the risk of infection, the patient is asked to stay away from crowded places and is also asked to wear masks. Q: When was this therapy started in India and what is the success rate? A: In India this treatment for blood cancer was started about 6 months back. The success rate varies from doctor to doctor. For us, the success rate has been about 95%. I was the one to have started this treatment for solid tumors- like the one Ravi Prakash is undergoing and this was first done in the last week of May 2024. It is a little too early to give a definite success rate for this and at least five to six months need to be given to give a sustained success rate. Q: How is Ravi Prakash responding to the treatment? A: He is doing very well till now. He has developed a slight cough and there is no major side effect as well. In CAR T- cell therapy, the side effects are also related to the efficacy effects. When the tumor cells start dying, the patient can develop fever, breathing issues or a drop in the blood pressure. Similarly, if the tumor is in the lungs, when CAR T- cell therapy starts working the patient tends to develop a cough which is more an efficacy related side- effect. There are side effects and all are manageable by the experts. Ravi Prakash is an example for other patients. When the patient is mentally strong, it also boosts the doctors confidence. Q: What would be the cost of this treatment? A: The cost varies according to the patients age, the type of cancer and also the stage of the disease. In India the cost is between Rs 40 lakhs to Rs 1 crore. CAR T- cell therapy also depends on the weight of the patient and the number of cycles required. If the cells are being manufactured in India or neighbouring countries, then the cost is about Rs 40 lakhs. But if the cells are being manufactured in the USA, then there are additional charges like GST, import duty. Additionally, there are special flights to transport them which are very expensive. In USA, the minimum cost for this treatment is approximately Rs 5.5 crore to Rs 8.5 crore depending on the hospital whereas in Europe or Singapore the estimated cost is about Rs 4 crore to Rs 5.5 crore. In comparison the treatment here is at a low cost. Once the cells start being manufactured in India the cost will come down substantially. Our motto is to make advanced cancer therapies accessible in India and that too at a low cost.

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