Chimeric antigen receptor-based immunotherapies in cancer treatment: An Indian perspective

Among non-communicable diseases, cancer has become the prime cause of morbidity and mortality worldwide. India is in third position after China and the USA, having approximately 1.46 million new cases reported in 2022. Traditional treatments, including chemotherapy and radiotherapy, have limitations such as systemic toxicity, drug resistance and recurrence. Therefore, there is an urgent need for novel targeted therapies. Chimeric antigen receptor (CAR)-based targeted immunotherapies, including CAR T-cell (CAR-T) and CAR Natural killer (CARNK) cell treatments, are now revolutionising cancer treatment. The current scenario of advanced CAR therapies in India indicates that India has achieved a significant milestone by developing and testing its indigenous CAR-T (NexCAR19) therapy with a 73% overall response rate in B-cell cancer patients. The Central Drugs Standard Control Organization has approved NexCAR19 under restricted emergency use in 2023. Another CAR-T therapy (Varnimcabtagene autoleucel) developed and tested by Immuneel Therapeutics, along with Christian Medical College Vellore and Miltenyi Biotec, reported 100% and 50% complete remission rates for B-cell acute lymphoblastic leukaemia and diffuse large B-cell lymphoma patients, respectively. Regardless of global progress with promising safety and efficacy, no clinical trials of CAR-NK therapy have yet been conducted in India, stressing the need for innovative research and clinical studies. The CAR-T and CAR-NK therapies have great potential in India. To understand their potential, a multifaceted approach is essential. Emphasis should be given to indigenous innovation, equitable healthcare policies and a collaborative framework to ensure their affordability, sustainability and broader applicability in the Indian population.