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Dr. Sravan Kumar Dubasi, Monday, April 22, 2024

Demystifying CAR-T Cell Therapy: A Guide to Understanding the Breakthrough Treatment

What is CAR-T Cell Therapy?

CART Chimeric antigen receptor T cell therapy is a type of immunotherapy. Chimera is a literal term for fusion. Elaborating the process in simple terms, initially patients T cell are collected from the blood when the cancer is in remission. These T cells are then genetically modified by viruses which doesn’t cause the disease. Modified T cells produce specialized receptors on the surface of the T cells are called Chimeric Antigen Receptors (CARs). Now these T cells are further cultured to produce millions of CARTs. Final product CARTs are then infused to the patient which bind to the specific antigen on the cancer cells and kill them.

Where is CAR-T Cell Therapy approved?

CARTs are being extensively investigated in both hematological and solid malignancies. But for now they are approved in ALL, Lymphomas and Multiple myeloma. A word of caution is necessary here. As of today they are not approved in the first line of management of any of the above mentioned malignancies. They are used in the patients who are relapsed and refractory, who are exhausted of their therapeutic options including bone marrow transplantation

What are the side effects of CAR-T Cell Therapy?

CART cells, as they are genetically modified cells do come with side effects. Commonly expected side effects cytokine release syndrome, neutropenia, infections and rarely neurologic sequalae. However these side effects can be addressed with the timely intervention.

Can CAR-T cell therapy cure the cancer?

As the evidence suggests CARTs are very effective in eradicating cancer in many patients and the benefits can be long lasting for many years when these are used even after multiple lines of treatment. In future, hopefully they might be more curative when they are used in the earlier lines of treatment.

How CAR-T is different from bone marrow transplantation?

In Bone marrow transplantation (BMT) we collect the stem cells from patient’s blood or relatives blood depending on the type of bone marrow transplantation and then infuse them to patient after high dose chemotherapy. Here chemotherapy helps in killing cancer and BMT helps in the recovery of the blood cells. Whereas, in CART cell therapy T cells are collected from the patient when his/her disease is in remission and T cells are genetically modified to act specifically against the antigen of cancer cells and thus kill the cancer cells.Liquid Biopsies: Discuss the role of liquid biopsies in cancer detection and monitoring treatment response, highlighting their advantages over traditional tissue biopsies.

What is a liquid biopsy?

A liquid biopsy is a non-invasive laboratory test that examine blood, urine and other body fluid samples for the detection of the cancer. As the cancer grows it sheds off cancer cells, DNA, RNA and other molecules into the blood, urine and other body fluids. Liquid biopsy helps in identifying these.

How is it different from traditional biopsy?

In a traditional biopsy a tissue from specific organ is needed for diagnosis of a cancer. It requires invasive method to get this tissue which is a painful procedure. It takes time to arrange for biopsy and needs further time for pathological evaluation. In total turnaround time for complete diagnosis takes around 2 weeks. With liquid biopsy it can be decreased to nearly a week. 

How does it help in the treatment of cancer?

Liquid biopsy is intended to help in diagnosing and planning cancer treatment. In fact, it can also help in identifying the treatment resistance mechanisms. As of now liquid biopsy isn’t always reliable to diagnose a cancer, traditional biopsy is required.

Where is it approved?

Till date only 5 different types of liquid biopsies are approved by US FDA. These biopsies are either used in the diagnosis, planning treatment and monitoring resistance mechanisms in cancers. Most important and significant test among these are the mutation testing and resistance mechanism testing of EGFR in Lung cancer

Does it help in monitoring treatment response?

Yes, liquid biopsy can help in monitoring treatment responses of cancers. However, it’s in the preliminary stages of research to use it clinically. Lot of research being done on the same and it can be available to use clinically in the near future. 

Does liquid biopsy help in the screening of cancer?

Research is being done to screen the cancers using liquid biopsy but so far none of the tests are approved to screen for the cancers.



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