嵌合抗原受体 T 细胞靶向实体瘤:当前的挑战和现有策略。

Chimeric Antigen Receptor-T Cells for Targeting Solid Tumors: Current Challenges and Existing Strategies.

机构信息

Celyad SA, Mont-Saint-Guibert, Belgium.

University Hospitals Leuven and KU Leuven, Leuven, Belgium.

出版信息

BioDrugs. 2019 Oct;33(5):515-537. doi: 10.1007/s40259-019-00368-z.

Abstract

Chimeric antigen receptor-T cells (CAR-Ts) are an exciting new cancer treatment modality exemplified by the recent regulatory approval of two CD19-targeted CAR-T therapies for certain B cell malignancies. However, this success in the hematological setting has yet to translate to a significant level of objective clinical responses in the solid tumor setting. The reason for this lack of translation undoubtedly lies in the substantial challenges raised by solid tumors to all therapies, including CAR-T, that differ from B cell malignancies. For instance, intravenously infused CAR-Ts are likely to make rapid contact with cancerous B cells since both tend to reside in the same vascular compartments within the body. By contrast, solid cancers tend to form discrete tumor masses with an immune-suppressive tumor microenvironment composed of tumor cells and non-tumor stromal cells served by abnormal vasculature that restricts lymphocyte infiltration and suppresses immune function, expansion, and persistence. Moreover, the paucity of uniquely and homogeneously expressed tumor antigens and inherent plasticity of cancer cells provide major challenges to the specificity, potency, and overall effectiveness of CAR-T therapies. This review focuses on the major preclinical and clinical strategies currently being pursued to tackle these challenges in order to drive the success of CAR-T therapy against solid tumors.

摘要

嵌合抗原受体-T 细胞(CAR-T 细胞)是一种令人兴奋的新型癌症治疗方法,最近有两种针对特定 B 细胞恶性肿瘤的 CD19 靶向 CAR-T 疗法获得监管批准,就是这种方法的例证。然而,这种在血液系统疾病中的成功尚未转化为实体瘤治疗中显著水平的客观临床反应。这种转化的缺乏无疑是由于实体瘤对包括 CAR-T 在内的所有治疗方法都提出了实质性的挑战,这些挑战与 B 细胞恶性肿瘤不同。例如,静脉输注的 CAR-T 细胞可能会迅速与癌变的 B 细胞接触,因为它们往往都存在于体内相同的血管区域。相比之下,实体瘤往往形成离散的肿瘤肿块,具有免疫抑制性的肿瘤微环境,由肿瘤细胞和非肿瘤基质细胞组成,由异常血管供应,限制淋巴细胞浸润并抑制免疫功能、扩展和持续。此外,肿瘤抗原的独特性和均一性表达的缺乏以及癌细胞的固有可塑性,对 CAR-T 疗法的特异性、效力和整体效果构成了重大挑战。这篇综述重点介绍了目前正在探索的主要临床前和临床策略,以应对这些挑战,推动 CAR-T 疗法在实体瘤中的成功应用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5603/6790340/edeba80d848a/40259_2019_368_Fig1_HTML.jpg

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