Aiims in process of making low cost therapy for treating multiple myeloma

Doctors at AIIMS, Delhi are in the process of developing a low cost antibody-based adaptive cellular therapy for treatment of multiple myeloma, a form of blood cancer.

This kind of therapy is expected to make advanced treatments like CAR-T cell therapies more affordable and accessible for patients in India.

The Chimeric antigen receptor (CAR) T-cell therapy is a form of adaptive cellular therapy in which a patient's T cells are isolated, genetically modified and infused back in the patients body to recognise and kill the cancer cells, said Dr Mayank Singh, Additional Professor in the Department of Medical Oncology at Dr B R Ambedkar Institute Rotary Cancer Hospital, (BRAIRCH), AIIMS here.

 

It is based on targeting B-cell maturation antigen (BCMA) which helps to target specific tumour antigens which are found cancer cells specially in cases multiple myeloma.

"So the therapy developed by the AIIMS researchers recognises BCMA as a target on multiple myeloma cells to eliminate them," Singh said.

As of now, the therapy has been tested on animal models and has shown promising outcomes, he said.

"We intend to take this CAR-T cell therapy for phase-1 clinical trials on humans in the near future to collect substantial evidence regarding its safety and efficacy. Our aim is to bring the cost of this therapy significantly down. There are other forms of CAR-T cell therapies but the cost of which are significantly high," he said.

Cancer is a life threatening disease characterized by uncontrolled growth of cancerous cells. Generally all the cancer cells are derived from a single cell which has undergone a sequence of mutation which have converted them to cancerous cell and these cells are involved in different symptoms associated with cancer, Singh explained.

Cancer cells proliferate at a very rapid pace which deprive normal cells of nutrients resulting in cancer associated cachexia.

Multiple myeloma is a form cancer of the plasma cells which are a type of white blood cell (WBC) that produces antibodies against infection. When these cells become cancerous, they multiply at rapid pace and crowd out normal blood-forming cells in the bone marrow. This form of cancer is often associated with relapse, Singh said.

Traditional cancer treatments like chemo/radiotherapy target rapidly dividing cells but this approach leads to cytotoxicity in normal cells as well leading to severe side effects associated with cancer treatment often leading to fatal outcome, he said.

Last two decades have seen emergence of targeted therapies in cancer which is associated with targeting inherent vulnerabilities of cancer cells like too much dependence on one protein for cancer cells which has improved outcome in cancer treatments however cancer cells eventually develop resistance to these agents which leads to cancer relapse, he elaborated.

Last decade has seen the emergence of immunotherapy as one of the cornerstones of cancer therapeutics with monoclonal antibodies being used to target cancer cells.

In a classical approach often these antibodies against a cancer target are loaded with the drug of interest for targeted delivery of chemotherapeutic drug thereby reducing the off target effect and improving their effectiveness, Singh said.

"Antibody based therapies have ushered a new era in cancer therapeutics including development of cellular CAR-T cell therapies which include components of these antibodies to target the antigen on the cancerous cell. Immunotherapies however remain expensive thereby being out of reach for majority of the population in countries like India," he explained.

According to latest data from National cancer registry, the estimated number of incident cases of cancer in India in 2022 was found to be 14,61,427. Furthermore, one in nine people are likely to develop cancer in his or her lifetime.

The problem of delayed diagnosis combined with limited access to world class therapies is bound to create a significate health burden on India as cases are expected to rise exponentially in coming decade, Singh said.

The research group spearheaded by Singh has subsequently filed for an Indian patent for the antibody and in process of filing patent for their CAR-T cell therapy.

"The CAR-T cell therapies has changed the way we approach and treat cancer. Development of CAR-T cell therapy has been in the nascent state in India despite the rapid pace it is moving around the world," he said.