Hillerdal Victoria, Essand Magnus
Science for Life Laboratory, Department of Immunology, Genetics and Pathology, Uppsala University, 751 85, Uppsala, Sweden,
BioDrugs. 2015 Apr;29(2):75-89. doi: 10.1007/s40259-015-0122-9.
Cancer immunotherapy was selected as the Breakthrough of the Year 2013 by the editors of Science, in part because of the successful treatment of refractory hematological malignancies with adoptive transfer of chimeric antigen receptor (CAR)-engineered T cells. Effective treatment of B cell leukemia may pave the road to future treatment of solid tumors, using similar approaches. The prostate expresses many unique proteins and, since the prostate gland is a dispensable organ, CAR T cells can potentially be used to target these tissue-specific antigens. However, the location and composition of prostate cancer metastases complicate the task of treating these tumors. It is therefore likely that more sophisticated CAR T cell approaches are going to be required for prostate metastasis than for B cell malignancies. Two main challenges that need to be resolved are how to increase the migration and infiltration of CAR T cells into prostate cancer bone metastases and how to counteract the immunosuppressive microenvironment found in bone lesions. Inclusion of homing (chemokine) receptors in CAR T cells may improve their recruitment to bone metastases, as may antibody-based combination therapies to normalize the tumor vasculature. Optimal activation of CAR T cells through the introduction of multiple costimulatory domains would help to overcome inhibitory signals from the tumor microenvironment. Likewise, combination therapy with checkpoint inhibitors that can reduce tumor immunosuppression may help improve efficacy. Other elegant approaches such as induced expression of immune stimulatory cytokines upon target recognition may also help to recruit other effector immune cells to metastatic sites. Although toxicities are difficult to predict in prostate cancer, severe on-target/off-tumor toxicities have been observed in clinical trials with use of CAR T cells against hematological malignancies; therefore, the choice of the target antigen is going to be crucial. This review focuses on different means of accomplishing maximal effectiveness of CAR T cell therapy for prostate cancer bone metastases while minimizing side effects and CAR T cell-associated toxicities. CAR T cell-based therapies for prostate cancer have the potential to be a therapy model for other solid tumors.
癌症免疫疗法被《科学》杂志编辑选为2013年度重大突破,部分原因是嵌合抗原受体(CAR)工程化T细胞的过继性转移成功治疗了难治性血液系统恶性肿瘤。使用类似方法有效治疗B细胞白血病可能为未来实体瘤的治疗铺平道路。前列腺表达许多独特的蛋白质,而且由于前列腺是一个非必需器官,CAR T细胞有可能用于靶向这些组织特异性抗原。然而,前列腺癌转移灶的位置和组成使治疗这些肿瘤的任务变得复杂。因此,与B细胞恶性肿瘤相比,前列腺转移瘤可能需要更复杂的CAR T细胞方法。需要解决的两个主要挑战是如何增加CAR T细胞向前列腺癌骨转移灶的迁移和浸润,以及如何对抗骨病变中发现的免疫抑制微环境。在CAR T细胞中加入归巢(趋化因子)受体可能会改善它们向骨转移灶的募集,基于抗体的联合疗法使肿瘤血管正常化也可能有同样效果。通过引入多个共刺激域来最佳激活CAR T细胞将有助于克服来自肿瘤微环境的抑制信号。同样,与能降低肿瘤免疫抑制的检查点抑制剂联合治疗可能有助于提高疗效。其他巧妙的方法,如在识别靶标时诱导免疫刺激细胞因子的表达,也可能有助于将其他效应免疫细胞募集到转移部位。虽然前列腺癌的毒性难以预测,但在使用CAR T细胞治疗血液系统恶性肿瘤的临床试验中已观察到严重的靶向/脱靶毒性;因此,靶抗原的选择至关重要。本综述重点关注在将副作用和CAR T细胞相关毒性降至最低的同时,实现CAR T细胞疗法对前列腺癌骨转移灶最大疗效的不同方法。基于CAR T细胞的前列腺癌疗法有可能成为其他实体瘤的治疗模式。
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