从采血到肿瘤浸润：CAR-巨噬细胞疗法治疗实体瘤的治疗变异

INTRODUCTION: Engineering CAR-macrophages (CAR-Ms) has revolutionized the solid tumors immunotherapy, due to intrinsic anti-tumor capacity, phagocytosis ability, and immunomodulatory effects of macrophages in tumor microenvironment (TME) remodeling. METHODOLOGY: A literature review was conducted using databases including PubMed, Google Scholar, and Scopus. The data was extracted using relevant articles published from 1991 to 2026 based on key words such as Chimeric Antigen Receptor Macrophages, CAR-M, Immunotherapy Resistance, Solid Tumors, and Tumor Microenvironment.

AREAS COVERED: CAR-Ms originate from different sources, but in turn come with distinct advantages and challenges regarding scalability, polarization capacity, phenotype shift, antigen escape, and functional stability. Genetic engineering techniques are essential to increase CAR-M efficacy.

Along with intrinsic engineering, the integration of CAR-Ms with chemotherapy, radiotherapy, immune checkpoint inhibitors, and new methods, such as nanomedicine, enhances antitumor effects by modulating TME barriers and abrogation of immune evasion mechanisms. EXPERT OPINION/COMMENTARY: CAR-m therapy is represented as a promising next-generation treatment for solid tumors, due to its strength to overcome the challenges of lymphocyte approaches.

However, TME polarization and variability in patient response should be considered to achieve optimal efficacy. Future advancements should improve signaling design, integration of novel immunologic methods, TME modulation, and biomarker-guided patient stratification. Several treatments are currently available for solid tumors, including surgery, chemotherapy, and radiotherapy.

However, each of these approaches has important limitations, such as damage to healthy tissues, treatment resistance, or tumor recurrence. In recent years, immunotherapy has emerged as a newer strategy that aims to strengthen the body’s own immune system to recognize and fight cancer cells.

Although some immune-based treatments have shown promising results, many still face difficulties in treating solid tumors because immune cells often cannot effectively enter or survive within the tumor environment. Macrophages are immune cells that naturally move into tumors and remove harmful or damaged cells.

Therefore, one method of immunotherapy is to enhance macrophages. In this approach, a patient’s immune cells are genetically modified so that macrophages can recognize and destroy cancer cells more efficiently. Once inside the tumor, these cells can also send signals that attract other immune cells and help turn the tumor environment into one that supports an immune attack.

Scientists are also testing ways to improve this therapy by combining it with chemotherapy, radiation, immune-activating drugs, or nanotechnology. Although challenges such as tumor resistance and differences between patients still remain, CAR macrophage therapy represents a promising new strategy for treating difficult solid tumors.