What Is CAR-T Cell Therapy? The Science Explained Simply
The world of medicines, medical developments and cancer treatment is advancing at a rapid rate. CAR-T cell therapy in India for international patients is yet another major upgrade in this regard and it is becoming extremely famous. CAR-T cell therapy or Chimeric Antigen Receptor T-cell therapy is a next level immunotherapy that works by reprogramming a patient’s own immune cells to aim and destroy cancer cells. This therapy is mainly used against blood cancers. CAR-T Cell Therapy is widely known and accepted to be a more efficient and an advanced therapy to tackle cancer cells. Let us have a closer look at how exactly this therapy works:
- Firstly your doctor will extract a sample of your blood. Later the T-cells or the white blood cells mainly responsible to fight diseases are separated from it.
- Now scientists introduce a new and powerful genetic code into the T-cells. This is similar to a software upgrade over your computer. The cells gradually transform into CARs or Chimeric Antigen Receptors.
- Nextly the cells are left to grow until a whole battalion of cells is ready and this process takes about a period of 2-3 weeks.
- Now your body is prepared for the infusion. Chemotherapy is used to prepare your body to receive the newly developed CAR-T cells.
- Lastly the CAR-T cells are infused in your body via an IV. These cells act aggressively against cancer supporting cells in your body.
How T-cells are re-engineered to kill cancer
T cells are specially engineered cells which help in the destruction of cancer cells in the body mainly in the case of blood cancer. The reengineering of T cells follows a special manner with certain important stages. CAR-T cell therapy in India for international patients follows a structured manner. The advancement in cancer treatment therapies is quite appreciative. Here we explain about the step by step process of reengineering of T cells to kill cancer:
Step 1: Cell Collection of T-cells
Doctors take out blood from the patient via a process called leukapheresis. This is actually a process that separates the T-cells from the rest of the blood cells.
Step 2: Genetic Modification
Now the T-cells are genetically modified into the reprogrammed CARs. These cells help in attacking and destroying cancer cells.
Step 3 : Multiplication of cells
The newly engineered T-cells are now put in a lab incubator and made to multiply until the entire force of cells is ready to support the treatment.
Step 4: Body Preparation
Now the patient's body is prepared to receive the newly re-engineered cells into the body. Some old cells are taken out and a room is prepared for the newly prepared re-engineered cells. Chemotherapy plays an important role at this stage.
Step 5: The Infusion of cells
At the last stage the CAR T-cells are infused back into the patient’s bloodstream similar to a blood transfusion process. These cells are ready to fight back cancer cells in an aggressive manner.
Which cancers respond best to CAR-T ?
There are certain cancers that respond remarkablely well to CAR-T Cell Therapy. CAR-T for blood cancer in India is highly effective. Let us understand the list of cancers that respond well against cell therapy. CAR-T cell therapy in India for international patients includes treatment against all these types of cancers.
Diffuse Large B-cell Lymphoma (DLBCL)
This is the most common kind of non-Hodgkin lymphoma, for which treatments like Yescarta are used to fight the disease.
Acute Lymphoblastic Leukemia (ALL)
This cancer is found mainly in kids and young adults up to the age of 25. Cell therapy is found to be highly effective against this cancer.
Mantle Cell Lymphoma (MCL)
The Mantle Cell Lymphoma is a type of B-cell non-Hodgkin lymphoma and cell therapy is an effective treatment against the cancer.
Follicular Lymphoma (FL)
The Follicular Lymphoma is actually a slow-growing and non-Hodgkin Lymphoma that can be effectively treated by cell therapies.
Multiple Myeloma
Multiple Myeloma is a cancer of plasma cells that is always popular for responding highly well to cell therapy.
CAR-T vs conventional chemotherapy outcomes
Chemotherapy is a well established and highly popular treatment against cancer than the newly advanced cell therapy. Chemotherapy is said to have a number of medical complications and health related issues after the actual treatment is executed. On the other hand CAR-T Cells Therapy is a treatment that uses reprogrammed cells to fight cancer in an aggressive manner. Chemotherapy even damages the healthy cells and tissues while the treatment is in progress. Whereas cell therapy uses the blood cells against the cancer cells forming and multiplying in the body.
One thing to note is CAR-T Cells Therapy or chemotherapy cannot be considered as the best for a particular person. The selection of treatment depends upon the kind of cancer and the response a particular patient offers to the treatment. Considering treatment resistance and major side effects is also important while choosing the right treatment against cancer. CAR-T cell therapy in India for international patients can be a good option but certainly not the best. Each treatment or each therapy has its own advantages and disadvantages. One cannot jump to a conclusion that a particular therapy against cancer is the best.
India's CAR-T Breakthrough: NexCAR19 — A World-First Milestone
Hon’ble Prime Minister Shri. Narendra Modi announced this amazing advancement in India’s cancer treatment. This is among the most amazing and advanced milestones in the medical field of India. CAR-T cell therapy in India for international patients is a world class experience. The NexCAR19 India, which is the world’s first humanised CAR-T therapy, is advanced by India.
The advancement is aided by BIRAC and DBT. Cell therapy in India is becoming highly popular, modern and aided by a number of supportive agencies throughout the country like IIT Bombay. NexCAR19 India is turning out to be an amazing development in the country’s world class cancer treatment therapies. There is constant mentorship, promotion, development and funding to the NexCAR19 India programme making it a grand success.
IIT Bombay–Tata Memorial collaboration
The IIT Bombay has brought in a next generation in cancer care in collaboration with the Tata Memorial Centre or the TMC. This latest development is well known as NexCAR19 and this is the country's first home developed CAR-T cell therapy. One of the best things about this latest development in cancer care is it costs only about a 10th of the cost at other international locations. This treatment re-engineers immune cells to aim and completely destroy blood cancers in the body.
This success is a wonderful outcome of medical innovation, research, adequate funding, institutional support, academic studies and government aid. The NexCAR19 is also said to be a prominent initiative supporting the Indian government’s ‘Make in India’ campaign.
80% remission rate in Phase 1 trials
CAR-T cells have been proven to have some serious side effects over the human body. These complications include Immune effector cell–associated neurotoxicity syndrome ICANS and Cytokine Release Syndrome or CRS. It is highly important to manage these side effects with the right level of medical care. However CAR-T cell therapy is also more effective than other treatments against cancer like Chemotherapy.
This treatment is known to attack elements like glycolipids, proteins and carbohydrates. Development is constantly under progress to reduce any side effects occurring in the patients. There is a record of an 80% remission rate during the first trial. The advanced cell therapy is effective over a number of diseases including myocardial fibrosis, solid tumors, and autoimmune diseases. CAR-T cell therapy in India for international patients is effective against a number of malignant diseases.
Price: ~$15,000 vs. $400,000+ in the US
India is a globally affordable hub for the treatment of cancers and other life threatening diseases. CAR-T cell therapy is also among the most expensive treatments in the United States. However immunotherapy cost in India 2026 is comparatively lesser rates than most of the countries in the world including the US. The price of getting a cell therapy in the US can reach up to $ 4,00,000 or more. On the contrary this expense can only be about $ 15,000.
CAR-T cell therapy in India for international patients is popular for being an affordable affair and a single infusion at locations in the United States of America can cost more than the entire treatment process. The treatment becomes highly expensive in the United States of America due to the cost of hospital stays, the high pricing by the pharmaceutical companies and also custom manufacturing requirements.
Checkpoint Inhibitors & Other Immunotherapy Options in India
Checkpoint inhibitors work by blocking the checkpoint proteins that stop T cells from attacking cancer cells in the body. There are a number of checkpoint inhibitors and other immunotherapy options available in India which are highly affordable and are offered by a number of hospitals and cancer care centres all throughout the country. CAR-T cell therapy in India for international patients includes a systematic analysis of checkpoint inhibitors. The cost of this treatment ranges from 1,50,000 INR to 3,50,000 INR depending upon the drug type, dosage and the number of cycles. Pembrolizumab, Atezolizumab, Durvalumab or Imfinzi, and Avelumab or Bavencio are popular checkpoint inhibitors in India.
Other immunotherapy options available in India are Cytokine therapies and Monoclonal antibody treatment. These treatments are best known for their effectiveness.
PD-1/PD-L1 inhibitors (Pembrolizumab, Nivolumab)
PD-1/PD-L1 inhibitors like Pembrolizumab or Keytruda and Nivolumab or Opdivo are some of the most amazing and effective immunotherapies. These checkpoint inhibitors stop checkpoint proteins which create a hurdle in the treatment of cancer. Cancer cells are aggressive and these inhibitors help in easing the treatment process.
The PD-1/PD-L1 inhibitors help in fighting the cancer in the body by applying brakes to the cancer cells development. Both these drugs have been proven to bring in an advancement in the field of oncology. These inhibitors are highly effective against Non-Small Cell Lung Cancer, Melanoma, (NSCLC), Hodgkin lymphoma and Head and Neck Squamous Cell Carcinoma.
Cost comparison for immunotherapy cycles
Immunotherapy charges and budget differ according to the drug type, therapy kind and even location. A normal cancer treatment course needs 4 to 12 cycles and its cost per cycle is generally between $2,000 to $6,000 per cycle in India. This cost is purely cheaper than the cost at European or American hospitals. Here are certain points explaining the determinants of cost of immunotherapies:
- Dosage is an important factor that affects the cost of immunotherapy and related treatments. Most of the time dosage and medication wastage depends upon the patient's weight and age.
- One of the most important determinants of the cost of immunotherapy is the number of cycles. The more the number of cycles the more the cost of immunotherapy treatment is.
- There are certain hospitals and cancer care centres in India that provide subsidized hospital care and treatment service. If this is so then immunotherapy treatments cost lower than usual.
- Another important determinant of the cost of an immunotherapy treatment in India or around the world is the class of hospital infrastructure and overheads. The more standardised and top notch hospital infrastructure the more the cost of immunotherapy is.
Here is a table explaining the cost comparison between various immunotherapies:
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KIND OF THERAPY
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COMMON DRUGS
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ESTIMATED COST ( PER CYCLE)
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MONOCLONAL ANTIBODIES
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Daratumumab, Rituximab
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$ 600 to $ 800
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ALLERGY IMMUNOTHERAPY
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SLIT and Allergy shots
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$ 60 to $ 180 per month
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CHECKPOINT INHIBITORS
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Opdivo
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$ 1,900 to $ 3,900
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CHECKPOINT INHIBITORS
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Pembrolizumab
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$ 2,300 to $ 5,300
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ADVANCED THERAPY
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CAR-T cell therapy
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$ 27,000 to 52,000
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Combination immunotherapy protocols
Combination immunotherapy protocols integrate various immunotherapies or mix them with traditional cancer care therapies like radiation and chemotherapy. This is done to tackle cancer in an immensely successful manner. Combination immunotherapy protocols are important for CAR-T cell therapy in India for international patients. These therapies work by increasing survival and success rates, aiming at reducing infections and improving response rates simultaneously. This offers a perfect defensive and attacking treatment strategy. Here are certain vital combination immunotherapy protocols for your knowledge:
Immunotherapy + Targeted TherapyAnti-PD-L1 + VEGF Inhibitor
Immunotherapy + Targeted TherapyAnti-PD-L1 + VEGF Inhibitor is a popular first-line protocol for renal cell carcinoma and hepatocellular carcinoma (HCC). It mixes bevacizumab and atezolizumab to support the immune system and stop the growth of tumors.
Checkpoint Inhibitor CombinationsCTLA-4 + PD-1/PD-L1 Blockade
Checkpoint Inhibitor CombinationsCTLA-4 + PD-1/PD-L1 Blockade is effective against advanced renal cell carcinoma, non-small cell lung cancer (NSCLC) and metastatic melanoma. It works with the impact of important medications like nivolumab and ipilimumab. This protocol helps by improving the immunity of the body against cancers.
Adoptive Cell Therapy
CombinationsCAR T-Cell Therapy + Checkpoints
Adoptive Cell Therapy
CombinationsCAR T-Cell Therapy + Checkpoints transform a patient's own T-cells. This protocol helps in depleting the cells responsible for the development of cancers.
Chemo-Immunotherapy Protocols.Pembrolizumab + Chemotherapy
Chemo-Immunotherapy Protocols.Pembrolizumab + Chemotherapy is used for various head and neck cancers. The mix of pemetrexed and platinum to PD-1 inhibitors leads to the death of immunogenic cells. It brings in T-cells and temporarily reduces regulatory T-cells.
Which Hospitals Offer CAR-T in India?
There are a number of hospitals in India that provide CAR-T in India. These hospitals are well equipped with some of the most advanced technologies for cell therapies. Here is a list of hospitals offering CAR-T in India based on the location:
Mumbai
Hospitals like Tata Memorial Hospital, Kokilaben Dhirubhai Ambani Hospital, and SunAct Cancer Institute, Jaslok Hospital are some hospitals in Mumbai offering CAR-T cell therapy treatment in India.
Bengaluru
HCG Cancer Centre at KR Road, Cytecare Hospitals, and Manipal Hospitals in Bangalore offer CAR-T therapy.
Delhi NCR
Hospitals in Delhi NCR offering this therapy are Medanta - The Medicity, Fortis Memorial Research Institute at Gurugram, Max Super Speciality Hospital at Saket), Amrita Hospital at Faridabad, and the All India Institute of Medical Sciences or AIIMS.
Kochi
Kochi has locations like Medical Trust Hospital, Amrita Hospital that provide CAR-T cell therapy.
Vellore
Christian Medical College or CMC at Vellore is well known for CAR-T treatment.
Chennai
Chennai also offers Apollo Cancer Centre and MGM Healthcare for CAR-T cell therapy.
Hyderabad
Hospitals like AIG Hospitals and Apollo Hospitals or Jubilee Hills are available at various locations in Hyderabad where CAR-T is offered.
IammunoACT-affiliated centres
There are a number of ImmunoACT affiliated centres that have connections with more than 80 hospitals and cancer care centres across the country that provide NexCAR19. Here is the list:
Bengaluru & Karnataka
Centres like HCG Cancer Center, Aster CMI Hospital & Aster Whitefield Hospital, Bharath Hospital & Institute of Oncology at Mysore and Manipal Hospital at Bengaluru and Karnataka are authorised.
Mumbai & Maharashtra
Authorised centres like Tata Memorial Hospital, Kokilaben Dhirubhai Ambani Hospital at Andheri West, Sir H. N. SunAct Cancer Institute at Thane, Reliance Foundation Hospital at Girgaon are available within the geographical location of Maharashtra.
Kerala and Other locations
Cancer care centres like Amrita Hospital at Kochi, Manipal Hospital at Vijayawada and Apollo Cancer Centres at Pan-India are some popular ImmunoACT affiliated centres located in Kochi and other locations.
Apollo & Fortis Hospital leading clinical trials
Apollo and Fortis Hospital is a leading hospital in India that has been constantly and consistently working towards the advancements in oncology care and treatment. The hospitals have been active for the last 25 years with more than 1400 clinical trials. There are about 200 main investigators working towards the development of this medical advancement. The hospitals are well equipped and fully accredited by the top accreditation institutions in the country and abroad.
It even connects with the top research and clinical centres around the Mumbai location. The hospitals are researching and developing medical advancements in the segments like Cardiology, Precision oncology, and targeted immunotherapies like CAR T-cell therapy. Apollo and Fortis Hospital even undertakes a number of research and development programmes, professional training and seminars focusing on medical advancements.
Eligibility requirements for international patients
The eligibility requirements for CAR-T cell therapy in India for international patients can be categorised into two prominent segments. Let us know about the same in detail:
Travel Eligibility Requirements
- The patients coming to India for CAR-T cell therapy should present all the original diagnostic reports including the genetic and biopsy reports along with the preliminary consultation records too.
- Patients planning for a CAR-T cell therapy in India should plan well in advance for a medical Visa and Medical Visa Invitation Letter to be eligible for a proper treatment in India.
Medical Eligibility Requirements
- The patients coming to India for CAR-T cell therapy should have sufficient heart, kidney and liver function to cope up with the side effects of the treatment.
- The patient should be in a condition of mobility and should be able to perform normal chores without much dependence. The patient should be diagnosed with serious blood cancers like Lymphoma and Leukemia to be eligible for CAR-T cell therapy in India.
Side Effects & Support During Immunotherapy in India
There can be certain side effects of immunotherapy treatment over the patient's body. Side effects can include:
- Hair loss
- Nausea
- Vomiting
- Diarrhea
- Thyroid issues
- Pneumonitis
- Skin dryness
The side effects are conveniently managed by hospital management, telemedicine follow ups, 24/7 oncology emergency helplines and also special monitoring teams. Video consultation services are also available at top notch hospitals in India. Dietitians, physiotherapists, and pain-management specialists are also in place at various hospitals that help in managing these side effects.
Cytokine Release Syndrome (CRS) management
Cytokine Release Syndrome requires immediate and effective management. An analysis of CAR-T cell therapy in India for international patients is literally incomplete without understanding the CRS management. Here is how it can be managed in a medically professional manner:
- Intensive supportive care is required to manage immense side effects like severe hypotension, respiratory failures and kidney issues.
- Cytokine inhibitors like Siltuximab, Anakinra and Tocilizumab are recommended for a supportive treatment against side effects.
- Corticosteroids are also used to manage the CRS symptoms. These are powerful anti-inflammatory agents that reduce the immune response. Dexamethasone or methylprednisolone are used to reduce the CRS if inhibitors are not found effective against the syndrome.
Inpatient vs. outpatient protocols
Cell therapies like CAR-T can be delivered on an outpatient and inpatient basis. Knowing about the difference between the inpatient and outpatient protocols is important. CAR-T cell therapy in India for international patients largely depends upon these important protocols. The treatment is similar but it differs on certain important factors including care intensity, caregiver burden, monitoring and side effect management. Here is a tabular presentation of the point of differences between inpatient and outpatient protocols:
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PROTOCOL TYPE
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INPATIENT PROTOCOLS
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OUTPATIENT PROTOCOLS
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DAY OF INFUSION
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The patient is under continuous care and therapeutic alignments.
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The patient gets the infusion in the certified clinic and a 2 to 4 hours of patient infusion observation follows later.
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LOCATION LIMITATION
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The patient should essentially be in and around the hospital.
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The patient is treated without location restrictions.
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INTENSITY MONITORING
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Facilities like continuous care, intensive follow up and important checks are included here.
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Outpatient protocols work at ease but regular visits are still essential.
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PATIENT PROFILE
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Applicable and highly recommended for patients suffering from Complex health issues.
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Applicable for patients going through a lower tumor stage and the need for less intense care.
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SIDE EFFECT MANAGEMENT
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Quick and high level side effect management is active.
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The protocols are not as strong as the inpatient protocols.
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BASIC SETTING
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A specialised unit is assigned.
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A day hospital is in place.
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What families need to know during treatment
The cost of getting a CAR-T cell therapy in India for international patients is comparatively lower. One cannot just pack his/her bag and travel to India to get treated. Families of the patients need to know, plan and understand certain things during the treatment. Here are certain important points that you the families of the patients should know during the treatment process :
1. Accommodation and Search Logistics
The family of the patients under treatment at cancer hospitals in India should plan perfectly for the accommodation and logistics in India. India is a large country with a number of logistic options and transportation modes. The families should plan for a stay of about 3 to 6 months in India for adequate and sufficient treatment. Two caretakers are suggested to be with the patient under treatment in India. The caretakers should be able play various roles and handle important logistical, translation and miscellaneous tasks related to hospitals and care centres. Considering Medical Visa and Medical Attendant Visa is also important.
2. Medical Monitoring
CAR-T cell therapy involves a number of steps including ‘Leukapheresis’. The entire treatment is handled with care having a number of stages and phases. The medical monitoring process requires professional care and deep analysis all throughout the CAR-T cell therapy treatment. There are chances of certain side effects of the CAR-T cell therapy in India for international patients. Side Effects include the Cytokine Release Syndrome. These side effects should be managed in a medically professional way. The family of the patient must plan for a proper medical evaluation before going for the cell therapy for the patient.
3. Finance and Billing
CAR-T cell therapy is highly affordable and international patients can get it for a comparatively affordable price at most of the cancer treatment hospitals in India. The patient’s family should enquire about the additional costs including the bridging therapy, supportive treatments and other important professional care during the cell therapy. Understanding about the payment methods of the hospital is also very important. Patients' families should plan well in advance regarding the hospital’s payment structure and methods to avoid on time complications. It is better to be in touch with the hospitals international desk to get the right information at the right time.
4. Cultural Adaptation
India is a diverse country having a number of cultures, languages and traditional backgrounds. Patients coming to India and their families should consider this vast diversity of the country. It is important to understand the regional languages and regional etiquettes of the place where the patient and the family are planning to accommodate during their entire stay for treatment in India. It is better to be in touch with translators or translation apps to get the right information related to a patient's personal and medical care. A particular region's culture plays a very important role in the dietary habits. The patient’s family and the patient himself will need to be adapted to the dietary styles and patterns. This will help in a smooth cell therapy treatment experience in India.
5. Other Preparations
Families should be in touch with the recognised and experienced facilities for a proper virtual pre-assessment. Organizations like Apollo Hospitals, Tata Memorial Hospital in Mumbai and Fortis Healthcare are among the top firms to stay connected to. Understanding about the cost and budget is important to avoid future issues.
Frequently Asked Questions
1Q: Is CAR-T cell therapy available in India for foreign patients?
Ans: Yes, CAR-T cell therapy is easily available in India for global patients. This is possible because of home developed therapies like the popular NexCAR19. The country is turning out to be a famous medical tourism hub. There are a number of advanced immunotherapy treatments available in the country for about a price of $ 15,000 to $ 50,000 that is ₹25 to 40 Lakh and this cost is considerably less than the cost in Europe or USA.
2Q.How much does CAR-T therapy cost in India?
Ans: CAR-T cell therapy costs about $ 15,000 to $ 30,000 in India. This is highly cheaper than the rates prevailing at foreign locations like the USA, Germany or UAE. International patients can save up to 80 to 90% of the cost by getting the treatment done in India.
3Q: What is the success rate of NexCAR19?
Ans: The NexCAR19 has an Overall Response Rate (ORR) or success rate of 70% to 73% in patients with Lymphoma and Leukemia. About 50% to 60% of patients get a complete remission by this treatment.
