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:Overcoming resistance in glioblastoma immunotherapy: lessons from the past and opportunities for the future.
胶质母细胞瘤(GBM)是成人中侵袭性最强的原发性脑肿瘤,其特征为快速增殖、弥漫性浸润和强烈的治疗耐药,即使接受最大程度治疗,中位生存期仍约为 15 个月。
胶质母细胞瘤(GBM)是成人中最具侵袭性的原发性脑肿瘤,具有增殖迅速、弥漫浸润和治疗抵抗显著等特点;即使接受最大程度治疗,中位生存期仍约为15个月。免疫治疗已改善其他恶性肿瘤的结局,但由于GBM具有免疫豁免环境、广泛的免疫抑制网络和肿瘤异质性,其疗效有限。免疫检查点抑制剂、癌症疫苗、CAR-T细胞、溶瘤病毒和靶向微环境药物的临床试验大多未能带来持久生存获益,常受到T细胞浸润不足、抗原丢失及肿瘤微环境中多重冗余抑制机制的阻碍。从这些失败中获得的经验提示,必须采用基于机制的策略应对肿瘤免疫逃逸。新一代方法强调:预先调节肿瘤以增强其免疫可见性;靶向多个抗原以防止逃逸;优化CAR-T局部递送;将溶瘤病毒作为免疫催化剂而非单纯细胞毒性药物;以及有针对性地调节微环境以支持效应应答。整合这些认识,合理的联合策略有望使GBM免疫治疗从有限改善走向有临床意义的获益。严谨的转化研究、适应性试验设计和以生物学为指导的干预,是克服GBM复杂障碍并实现持久抗肿瘤免疫的关键。
Glioblastoma (GBM) is the most aggressive primary brain tumor in adults, characterized by rapid proliferation, diffuse invasion, and profound therapeutic resistance, leading to a median survival of approximately 15 months despite maximal treatment. Immunotherapy, which has transformed outcomes in other malignancies, has shown limited success in GBM due to its immune-privileged environment, extensive immunosuppressive networks, and tumor heterogeneity. Clinical trials of checkpoint inhibitors, cancer vaccines, CAR-T cells, oncolytic viruses, and microenvironment-targeting agents have largely failed to produce durable survival benefits, often hindered by poor T-cell infiltration, antigen loss, and redundant suppressive mechanisms within the tumor microenvironment. Lessons from these failures highlight the necessity of mechanism-informed strategies that address the tumor's immune evasion. Next-generation approaches emphasize priming the tumor to enhance immune visibility, targeting multiple antigens to prevent escape, optimizing locoregional CAR-T delivery, using oncolytic viruses as immune catalysts rather than sole cytotoxic agents, and strategically modulating the microenvironment to support effector responses. By integrating these insights, rational combination strategies can transform GBM immunotherapy from incremental efficacy to meaningful clinical benefit. Translational rigor, adaptive trial designs, and biology-driven interventions are essential to overcoming the complex barriers posed by GBM and achieving durable anti-tumor immunity.
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