Dept. of Immunology, H. Lee Moffitt Cancer Center and Research Institute. Tampa, FL, United States.
Dept. of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, United States.
Pharmacol Res. 2018 Mar;129:194-203. doi: 10.1016/j.phrs.2017.11.035. Epub 2017 Dec 1.
Cancer immunotherapies are dramatically reshaping the clinical management of oncologic patients. For many of these therapies, the guidelines for administration, monitoring, and management of associated toxicities are still being established. This is especially relevant for adoptively transferred, genetically-modified T cells, which have unique pharmacokinetic properties, due to their ability to replicate and persist long-term, following a single administration. Furthermore, in the case of CAR-T cells, the use of synthetic immune receptors may impact signaling pathways involved in T cell function and survival in unexpected ways. We, herein, comment on the most salient aspects of CAR-T cell design and clinical experience in the treatment of solid tumors. In addition, we discuss different possible scenarios for combinations of CAR-T cells and other treatment modalities, with a special emphasis on kinase inhibitors, elaborating on the strategies to maximize synergism. Finally, we discuss some of the technologies that are available to explore the molecular events governing the success of these therapies. The young fields of synthetic and systems biology are likely to be major players in the advancement of CAR-T cell therapies, providing the tools and the knowledge to engineer patients' T lymphocytes into intelligent cancer-fighting micromachines.
癌症免疫疗法正在极大地改变肿瘤患者的临床治疗方式。对于许多这些疗法,其给药、监测和相关毒性管理的指南仍在建立中。对于经过基因修饰的过继转移 T 细胞来说,情况尤其如此,由于其在单次给药后具有复制和长期持续存在的能力,因此具有独特的药代动力学特性。此外,在 CAR-T 细胞的情况下,合成免疫受体的使用可能以出人意料的方式影响涉及 T 细胞功能和存活的信号通路。我们在此评论了 CAR-T 细胞设计和在实体瘤治疗中的临床经验的最显著方面。此外,我们讨论了 CAR-T 细胞与其他治疗方式联合的不同可能情况,特别强调了激酶抑制剂,并详细阐述了最大限度发挥协同作用的策略。最后,我们讨论了一些可用于探索这些疗法成功的分子事件的技术。合成和系统生物学这两个年轻的领域可能是 CAR-T 细胞疗法发展的主要参与者,为将患者的 T 淋巴细胞工程改造为智能抗癌微型机器提供了工具和知识。
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