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胶质母细胞瘤靶向嵌合抗原受体 (CAR) T 细胞疗法的潜力。

Potential of Glioblastoma-Targeted Chimeric Antigen Receptor (CAR) T-Cell Therapy.

机构信息

Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.

Glioblastoma Translational Center of Excellence, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.

出版信息

CNS Drugs. 2020 Feb;34(2):127-145. doi: 10.1007/s40263-019-00687-3.

Abstract

Despite the established efficacy of chimeric antigen receptor (CAR) T-cell therapy in hematologic malignancies, translating CAR T therapy to solid tumors has remained investigational. Glioblastoma, the most aggressive and lethal form of primary brain tumor, has recently been among the malignancies being trialed clinically with CAR T cells. Glioblastoma in particular holds several unique features that have hindered clinical translation, including its vast intertumoral and intratumoral heterogeneity, associated immunosuppressive environment, and lack of clear experimental models to predict response and analyze resistant phenotypes. Here, we review the history of CAR T therapy development, its current progress in treating glioblastoma, as well as the current challenges and future directions in establishing CAR T therapy as a viable alternative to the current standard of care. Tremendous efforts are currently ongoing to identify novel CAR targets and target combinations for glioblastoma, to modify T cells to enhance their efficacy and to enable them to resist tumor-mediated immunosuppression, and to utilize adjunct therapies such as lymphodepletion, checkpoint inhibition, and bi-specific engagers to improve CAR T persistence. Furthermore, new preclinical models of CAR T therapy are being developed that better reflect the clinical features seen in human trials. Current clinical trials that rapidly incorporate key preclinical findings to patient translation are emerging.

摘要

尽管嵌合抗原受体 (CAR) T 细胞疗法在血液恶性肿瘤中已被证实有效,但将 CAR T 疗法转化为实体瘤仍在研究中。胶质母细胞瘤是原发性脑肿瘤中最具侵袭性和致命性的一种,最近已成为用 CAR T 细胞进行临床试验的恶性肿瘤之一。胶质母细胞瘤尤其具有几个独特的特征,这些特征阻碍了临床转化,包括其广泛的肿瘤间和肿瘤内异质性、相关的免疫抑制环境以及缺乏明确的实验模型来预测反应和分析耐药表型。在这里,我们回顾了 CAR T 疗法发展的历史,它在治疗胶质母细胞瘤方面的当前进展,以及在将 CAR T 疗法确立为现有治疗标准的可行替代方案方面的当前挑战和未来方向。目前正在努力确定针对胶质母细胞瘤的新型 CAR 靶点和靶点组合,修饰 T 细胞以增强其疗效并使其能够抵抗肿瘤介导的免疫抑制,以及利用淋巴耗竭、检查点抑制和双特异性结合物等辅助疗法来提高 CAR T 细胞的持久性。此外,正在开发更好地反映临床试验中所见临床特征的新型 CAR T 疗法的临床前模型。正在出现快速将关键临床前发现转化为患者治疗的临床试验。

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