决定异体 CAR T 细胞排斥与扩增的细胞和分子机制
Cellular and molecular mechanisms determining allogeneic CAR T cell rejection and expansion.
我们评估了11例接受单一批次cemacabtagene ansegedleucel(cema-cel)治疗的大B细胞淋巴瘤患者,cemacabtagene ansegedleucel是一种异体抗CD19 CAR T产品。
英文原题:Accelerating CAR-T Cell Therapies with Small-Molecule Inhibitors.
CAR-T 细胞疗法显著提高了 B 细胞恶性肿瘤患者的生存率。
CAR-T 细胞疗法显著提高了B细胞恶性肿瘤患者的生存率。然而,其在急性髓系白血病等其他血液系统癌症及实体瘤中的疗效有限。主要障碍包括癌细胞抗原表达下调或丢失、靶细胞可及性受限,以及这些“活体药物”在高度免疫抑制性肿瘤微环境中的持久性较差。此外,免疫疗法制备面临重大挑战,患者也常出现细胞因子释放综合征和免疫效应细胞相关神经毒性综合征等副作用。本综述着重介绍小分子抑制剂的潜力,其中许多已获准临床使用;这类药物可能有助于CAR-T细胞制备、提高抗肿瘤效力并减轻副作用。尽管仍需大量研究,但稳健的临床前数据和不断增长的临床关注度表明,利用癌症信号通路抑制剂增强并改进CAR-T疗法具有显著前景,适用于血液系统恶性肿瘤及实体瘤。探索这些联合策略有望带来更有效的治疗,为耐药癌症患者提供新希望。
Chimeric antigen receptor T-cell therapies have markedly improved the survival rates of patients with B-cell malignancies. However, their efficacy in other hematological cancers, such as acute myeloid leukemia, and in solid tumors has been limited. Key obstacles include the downregulation or loss of antigen expression on cancer cells, restricted accessibility to target cells, and the poor persistence of these "living drugs" because of the highly immunosuppressive tumor microenvironment. Additionally, manufacturing these immunotherapies presents significant challenges, and patients frequently experience side effects such as cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome. This review emphasizes the potential of small-molecule inhibitors, many of which are already approved for clinical use, to facilitate chimeric antigen receptor T-cell manufacturing, enhance their anti-tumor efficacy, and mitigate their side effects. Although substantial work remains, the robust pre-clinical data and the growing clinical interest suggest significant promise for using cancer signaling pathway inhibitors to enhance and refine chimeric antigen receptor T-cell therapy for both hematological and solid tumors. Exploring these combination strategies could lead to more effective therapies, offering new hope for patients with resistant forms of cancer.
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