Health Issues | Nine-year-old Ishwari is now cancer-free.The treatment that saved her life will be available by the end of the year

Meet nine-year-old Ishwari Bagirav, a strong-willed girl who dreams of becoming a makeup artist. Her fascination with cosmetics knows no bounds as she gleefully tries on her mother’s cosmetics.

Despite Ishwari’s lack of interest in academics, her parents and teachers were unfazed. Her life is different from most kids her age. At age six, she was diagnosed with acute lymphoblastic leukemia (ALL), a cancer of the blood and bone marrow.

Despite several painful rounds of chemotherapy at the Tata Memorial Center in Mumbai, the cancer kept coming back. Even after lengthy and painful treatment, the disease relapsed. But Ishwari’s story changed dramatically with CAR-T cell therapy.

Ishwari, a resident of Nashik, became one of the first participants in a pediatric trial of CAR-T cell therapy, a breakthrough treatment for certain types of cancer. Miraculously, during the initial stages of the trial, Ishwari defied the odds and was declared cancer-free.

“My wife and I were in shock (when she was diagnosed). Our daughter was dying anyway, so we decided to give her a chance with this trial,” Ishwari’s father Bagirav ), a local car driver, told News18 over the phone.

“About 1.5 years later, Ishwari is in complete remission mode, which means she is now cancer-free,” said Dr. Gaurav Narula, program director at the Center for CAR-T and Cell Therapy at Tata Memorial Center, Ishwari’s healthcare provider.

Ishwari’s father told News18 that she is now eating well and as active as other children. “She played and went to school regularly. However, we would continue to follow up with check-ups and blood tests,” her father said, recalling a time when Ishwari’s survival seemed uncertain.

“I still remember those days when my wife and I cried all day long. It felt like a curse, but we are grateful that we took the opportunity with CAR-T therapy.”

Ishwari’s journey symbolizes hope for countless children battling life-threatening cancer. Her resilience and the potential success of her treatment offer a glimmer of hope for young warriors like her to have a brighter, cancer-free future.

“Ongoing pediatric trials await the completion of the second phase by the end of this year. The therapy is expected to receive commercial approval for pediatric use later this year,” said Narula, who is also the director of pediatric oncology and health sciences at Tata Memorial Centre. professor.

“Acute lymphoblastic leukemia is one of the most common cancers in children. There are many more children like Ishwari who are witnessing extremely encouraging results in trials.”

The clinical trial was conducted by Narula and his team at Tata Memorial Centre.

Chimeric Antigen Receptor (CAR) T-cell therapy or CAR-T cell therapy is a “first in India” gene therapy and is currently in the second phase of pilot clinical trials in children. It has been commercially launched in adults, meaning private hospitals can now purchase the treatment for patients. So far, three of the 15 commercial patients have seen their cancer go into remission.

How does CAR-T work?

In India, the cancer challenge is escalating into a major public health issue. Recent estimates indicate a sharp increase in new cancer cases, reaching nearly 1.6 million in 2023, compared with approximately 980,000 in 2010. Sadly, approximately 800,000 people die from cancer each year, and this number is expected to increase significantly in the coming years.

In India, nearly 50,000 new cases of childhood cancer occur every year.

Tata Memorial Center is one of the oldest and largest cancer centers in the world, registering more than 2,500 cancer patients aged 0 to 15 years every year. Of these patients, approximately 1,000 have blood cancer.

During treatment, blood is drawn from the patient’s body. Doctors then remove a special type of white blood cell called a “T cell” from the blood. These T cells are programmed in the laboratory to recognize and attack cancer cells in the patient’s body. The cells are manufactured in a GMP-certified manufacturing unit and ultimately returned to the patient.

“Once these cells find cancer cells in the body, they start multiplying and attacking the cancer cells. This is an army of cells that are trained to kill cancer cells in the body,” Narula explains. “This is living blood that is programmed to eliminate cancer cells.”

The history of domestic CAR-T and global therapy

In 2017, U.S. health regulators approved CAR-T therapy for adults. The therapy is priced at $450,000, which is approximately Rs 373 crore at the latest dollar exchange rate. The technology is also available in several other developed countries, including Europe and China.

However, when imported to Indian patients, the price is much higher as it includes expenses such as hospital fees, doctor and administrative feed, etc., which is unaffordable for most Indians.

“China also has the technology. However, patients need to fly to the country to complete the entire treatment process,” Narula said, adding that Indian technology has brought the cost down to less than Rs 50 lakh. “The price is around Rs 42 to 45 lakh.”

In June 2021, India launched a clinical trial to develop domestically produced CAR-T for adults. The trial, launched in partnership with Tata Memorial Center and IIT Bombay, entered Phase 2 in December 2022 and received commercial approval in October 2023. The trial is financially supported by ImmunoACT, a spin-out company affiliated with IIT Bombay.

The approval stems from results from two small clinical trials conducted in India, involving 64 individuals diagnosed with advanced lymphoma or leukemia. Results presented at the American Society of Hematology meeting in December 2023 showed that 67% of patients in the combination trial (36 of 53 patients) experienced a significant reduction in cancer severity (objective response), with half achieving a complete response.

Of the 53 participants, none experienced neurological side effects common to U.S.-approved CAR T-cell therapies. Furthermore, only a small proportion (5%) experienced serious immune-related side effects.

Evolving technology

Narula said CAR-T is currently approved to treat B-cell lymphoma and leukemia. “Currently, CAR-T has been shown to be effective in treating B-cell malignancies. However, in the coming years, it could be used to treat solid tumors, neuroblastoma, and other types of blood cancers.”

“In addition, we need to understand why some patients do not respond to this therapy,” he said, adding that while the treatment has not yet shown significant side effects, going forward we will gain insights into its long-term effects.

CAR-T therapy offers a glimmer of hope for people like Ishwari and those who might otherwise lose hope of survival. In the coming years, it has the potential to help the world fight this devastating disease.