NexCAR19: India’s First Living Drug for Cancer Treatment

Cancer is a life-threatening disease that occurs due to the uncontrolled growth of some abnormal cells in the body. In recent years, it is estimated that cancer has become one of the leading causes of death worldwide.

In 2022, there were almost 20 million new cases of patients diagnosed with cancer, and it is estimated by researchers that by 2040, the number of new cases is expected to rise to about 29.9 million.

Cancer can be treated in a number of ways, such as chemotherapy, radiation therapy, and more. In recent years, several advanced methods have come up for the cure of cancer, and one of them is CAR T-cell.

CAR T-cell therapy was first introduced in the United States in 2017 and by using the NexCAR19™ (Actalycabtagene autoleucel), it arrived in India in 2023. Moreover, the Food and Drug Administration (FDA) has approved six CAR T-cell therapies. 

Let’s delve deeper into NexCAR19 therapy for cancer treatment. 

Understanding NexCAR19 Cancer Therapy

NexCAR19, a CAR T cell therapy, is a type of cancer immunotherapy. CAR T-cell therapy is indeed an advanced, innovative treatment, often referred to as a “living drug” because it involves genetically modifying a patient’s immune cells to fight cancer.

This therapy is prescribed for treating specific relapsed or refractory B-cell Hodgkin’s lymphomas and B-cell Acute Lymphoblastic Leukemia when other traditional treatments are not effective. 

How Does NexCAR19 Work?

To understand how NexCAR19 works, it’s essential to know how our immune system defends against foreign invaders.

Immune receptors and Foreign Antigens

Our immune system works like a guard, which recognizes foreign invaders in the body through proteins called antigens present on their surface and ultimately destroys them. T cells, white blood cells, have special proteins called receptors on the surface to detect and bind to antigens on the surface of foreign cells; thus, they help in destroying infected or cancerous cells. 

The relationship between the immune system and foreign invaders works like a lock and key mechanism. 

But sometimes what happens is that your immune cells do not have specific receptors for particular antigens or cancer cells; thus, they can’t attach to those cells and are also unable to destroy them. 

Chimeric Antigens Receptors (CAR)

In certain types of cancer cells, CD19 protein is present on their surface. Therefore, scientists designed unique proteins known as Chimeric Antigen Receptors (CARs) that are delivered through a lentiviral vector, a vehicle, to your T cells. Then, these modified T cells are delivered to your bloodstream so that they can bind to the CD19 antigen of cancer cells and ultimately destroy them. 

The Benefits of NexCAR19 Therapy: Why It’s Recommended

Here are some of the reasons why NexCAR19, a CAR T-cell therapy, is advised:

• When frontline treatment like chemotherapy or radiation therapy is not sufficient to achieve remission,
• The previous treatment failed, or
• Relapse occurred after a prior complete remission or after a prior stem cell transplant. 

The Complete Process of NexCAR19 Therapy for Cancer Treatment

The NexCAR19 therapy requires prior planning before undergoing treatment. The treatment process depends on the following factors: 

• Existing other diseases: If you have a high burden of other diseases, then the treatment is scheduled earlier to reduce the symptoms of the disease.
• Timing of prior treatment: certain prior immunotherapies or chemotherapies may negatively impact your quantity or quality of T-cells. Thus, your doctor may schedule the treatment plan accordingly. 

Here is the Complete Process of NexCAR19 Therapy

Treatment Considerations:

NexCAR19 may be recommended by your haematologist or medical oncologist if you were diagnosed with B-cell Hodgkin’s lymphomas and B-cell acute lymphoblastic leukaemia.  

Leukapheresis:

A process of collection of white blood cells. It is a daycare procedure and usually requires 4-6 hours. Then, the processing of the cells starts. 

Genetic Engineering:

In the laboratory, the scientist inserts a chimeric antigen receptor (CAR) gene into the T cells through a lentiviral vector,  which allows it to recognize and target specific proteins, such as CD19, found on the surface of cancer cells.

Cell Expansion:

Once the T cells are engineered, the number of T cells is expanded in a controlled environment. This is a crucial step to increasing T cells in a sufficient number. 

Interim Period:

After that, NexCAR19 usually requires 19 days for manufacturing. During this period, your doctor may administer a Bridging Therapy to lower the symptoms of the disease. 

Also, approximately 5 days before NexCAR19 infusion, you will start having conditioning chemotherapy so that your body will be ready for NexCAR19’s infusion. 

Reinfusion into the Patient:

The modified and expanded cells are reinfused back into the patient’s bloodstream. Now, these T cells are able to recognize and attack cancer cells that express the target antigen, leading to the destruction of cancerous cells.

Immune response activation:

Once inside the patient’s body, the modified T-cells proliferate and start attacking cancer cells. This can result in a significant reduction or even complete remission of the cancer, depending on the patient’s response.

Possible NexCAR19 Side Effects 

Unlike other CAR T-cell therapies, NexCAR19 therapy is designed specifically to limit the severity of side effects triggered by your immune system, thus minimizing your hospitalization time after infusion. 

Yet there are chances of having serious and life-threatening side effects. It is always recommended to consult with your doctor if you’re having any of the given symptoms. 

Cytokine Release Syndrome (CRS): As NexCAR19’s T cells multiply, there is also a possibility for the release of cytokines, a chemical that can cause complications. The signs and symptoms of CRS may include;

• Fever (100.4°F/38°C or higher) and chills
• Nausea and vomiting
• Rapid heartbeat
• Low blood pressure
• Dizziness and lightheadedness
• Fatigue or weakness

Nervous System Problem: NexCAR19 can also cause problems in the nervous system as well. Here are signs and symptoms related to that:

• Headache
• Confusions
• Agitation
• Seizures
• Changes in consciousness
• Difficulty in speaking and understanding
• Loss of balance

Other side effects: This may include the following signs and symptoms:

• Allergic reaction
• Abnormal levels of minerals in the blood, like low potassium, phosphorus, and sodium levels.
• Weakened your immune system
• Low blood count, called Hemophagocytic Lymphohistocytosis (HLH) and, if prolonged, low blood counts, called cytopenia, thus can increase the risk of infection, bleeding, fatigue, or bruising.
• Risk of having another cancer. 

Due to the severity level of side effects, doctors typically advise adult patients to avoid driving, managing heavy machinery, or involving in any dangerous activities for up to several weeks after treatment. 

Benefits of CAR T-cell (NexCAR19) Therapy

Here are the benefits of taking CAR T-cell therapy. 

• Offers better outcomes than traditional methods.
• Quick intervention time and requires a single infusion of CAR T cells.
• Shorter treatment time.
• Able to identify and destroy the cancer cells during relapse. 

Hospitals/Centers providing NexCAR19 (CAR T Cell Therapy) in India

India is emerging as a popular destination for providing different types of treatment options in India. Here is the list of hospitals that provide CAR T-cell therapies.

• Apollo Hospital
• Fortis Memorial Research Institute
• Amrita Hospital Faridabad
• Max Hospital Saket, New Delhi
• HCG Cancer Center

For more information about CAR T-cell therapy and its cost, Read CAR T-cell therapy cost in India. 

Key Insights

NexCAR19, is a humanized-designed CAR T cell therapy that is a groundbreaking advancement in cancer treatment. This therapy offers a personalized, targeted approach for patients with specific types of blood cancers like B-cell Hodgkin’s lymphoma and B-cell Acute Lymphoblastic Leukemia. 

For patients seeking this cutting-edge treatment, Medsurge India provides expert guidance and access to top-tier medical facilities in India, offering affordable, world-class care. As a trusted medical tourism company, Medsurge India ensures a seamless experience, from treatment planning to recovery, making advanced cancer therapies accessible to patients worldwide. 

Contact us if you need guidance regarding cancer treatment in India. 

FAQ’s about NexCAR19 therapy (CAR T cell therapy)

Q: How long does the entire NexCAR19 therapy process take?

A: The entire process of NexCAR19 therapy will take you several weeks. This includes the time for leukapheresis (the collection of white blood cells), genetic modification of the T-cells, and expansion of the modified cells. Additionally, there is a preparation period, including conditioning chemotherapy about 5 days before the reinfusion of the modified T-cells. 

Q: Is NexCAR19 suitable for all cancer patients?

A: No,  NexCAR 19 is specifically designed for certain specific cancers, such as B-cell Hodgkin’s lymphoma or B-cell Acute Lymphoblastic Leukemia (ALL). It is not suitable for all cancer types, and your doctor will determine if this therapy is appropriate based on the specifics of your condition and previous treatments. 

Q: Are there any special precautions that you may need to take after infusion with NexCAR19 and discharge? 

A: Following are the precautions that you need to take:

• Consume cooked meals that are prepared under hygienic conditions.
• Avoid crowded places to decrease the risk of infections.
• Follow-up regularly with your hematologist or medical oncologist.
• Do not start or stop any medication without any recommendation by your doctor.
• If you notice any side effects, it is always advisable to consult with your doctor prior to taking any actions  by yourself. 

Q: How many days will you need to follow up with a hematologist or medical oncologist?

A: After undergoing NexCAR19 therapy, follow-up visits with your hematologist or medical oncologist are crucial. After discharge, you may be asked to follow up weekly or twice a week for the first month. The frequency of follow-up will decrease with time, and if you achieve remission beyond 6 months, this frequency may shorten to twice a year. But it is also recommended to continue follow-ups for up to 15 years. 

Q: What is the cost of CAR T-cell therapy in India? 

A: The cost of CAR T-cell therapy in India varies depending on several factors, such as hospital, medical facility, patient’s condition, and specific treatment plan. Moreover, the CAR T-cell therapy cost in India is also reasonable as compared to other western countries.