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:Advanced therapies for stomach cancer.
胃癌(GC)仍然是全球重大健康挑战,尽管早期诊断和常规治疗取得了进展,但晚期疾病的预后仍然很差。
胃癌(GC)仍然是全球重大健康挑战,晚期疾病尽管在早期诊断和传统治疗方面取得了进展,其预后仍持续不佳。这种临床紧迫性推动了先进疗法的采用,包括分子靶向治疗和免疫治疗策略。人表皮生长因子受体2(HER2)靶向药物,包括曲妥珠单抗、曲妥珠单抗德鲁替康(T-DXd)和维迪西妥单抗(RC48),已在HER2阳性队列中显示出显著的生存获益,尽管瘤内异质性常常是获得性耐药的基础。以雷莫西尤单抗为代表的靶向血管内皮生长因子受体的抗血管生成治疗,仍然是晚期GC管理的基石。同时,针对程序性细胞死亡蛋白1和程序性细胞死亡配体1的免疫检查点抑制剂通过增强内源性抗肿瘤免疫扩大了治疗选择,尽管在不同分子亚型中疗效存在差异。新兴免疫疗法——如过继细胞疗法(例如CAR-T 细胞)、肿瘤相关抗原疫苗、免疫调节剂和基因工程溶瘤病毒——显示出有前景的临床前和早期临床活性。优化这些进展的关键在于对肿瘤免疫微环境的系统层面理解,该微环境动态调节治疗反应和免疫逃逸。未来的进展取决于三大支柱:(1)生物标志物驱动的治疗方案个体化,(2)克服原发性和适应性耐药机制的联合策略,以及(3)将多组学见解转化整合到治疗开发中。通过机制研究和创新试验设计来解决这些优先事项,对于在这种异质性恶性肿瘤中实现持久临床缓解和改善生存结局至关重要。
Gastric cancer (GC) persists as a major global health challenge, with advanced-stage disease exhibiting persistently poor prognoses despite advancements in early diagnosis and conventional treatments. This clinical urgency has driven the adoption of advanced therapies, including molecularly targeted therapies and immunotherapeutic strategies. Human epidermal growth factor receptor 2 (HER2)-directed agents, including trastuzumab, trastuzumab deruxtecan (T-DXd), and disitamab vedotin (RC48), have demonstrated significant survival benefits in HER2-positive cohorts, though intratumoral heterogeneity frequently underlies acquired resistance. Antiangiogenic therapies targeting the vascular endothelial growth factor receptor, exemplified by ramucirumab, remain a cornerstone of advanced GC management. Concurrently, immune checkpoint inhibitors against programmed cell death protein 1 and programmed cell death-ligand 1 have expanded therapeutic options by potentiating endogenous antitumor immunity, albeit with variable efficacy across molecular subtypes. Emerging immunotherapies-such as adoptive cell therapies (e.g., chimeric antigen receptor T-cells), tumor-associated antigen vaccines, immunomodulatory agents, and genetically engineered oncolytic viruses-show promising preclinical and early phase clinical activity. Critical to optimizing these advances is a systems-level understanding of the tumor-immune microenvironment, which dynamically regulates therapeutic response and immune evasion. Future progress hinges on three pillars: (1) biomarker-driven personalization of treatment regimens, (2) combinatorial strategies to overcome primary and adaptive resistance mechanisms, and (3) translational integration of multi-omics insights into therapeutic development. Addressing these priorities through mechanistic investigations and innovative trial designs will be essential to achieving durable clinical responses and improving survival outcomes in this heterogeneous malignancy.
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