Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia.
Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, NSW, Australia.
Adv Exp Med Biol. 2020;1263:117-143. doi: 10.1007/978-3-030-44518-8_8.
Chimeric antigen receptor T (CAR-T) cell therapy has dramatically revolutionised cancer treatment. The FDA approval of two CAR-T cell products for otherwise incurable refractory B-cell acute lymphoblastic leukaemia (B-ALL) and aggressive B-cell non-Hodgkin lymphoma has established this treatment as an effective immunotherapy option. The race for extending CAR-T therapy for various tumours is well and truly underway. However, response rates in solid organ cancers have been inadequate thus far, partly due to challenges posed by the tumour microenvironment (TME). The TME is a complex structure whose role is to subserve the persistence and proliferation of tumours as well as support their escape from immune surveillance. It presents several obstacles like inhibitory immune checkpoint proteins, immunosuppressive cells, cytokines, chemokines, stromal factors and adverse metabolic pathways. CAR structure and CAR-T therapies have evolved to overcome these obstacles, and we now have several novel CARs with improved anti-tumour activity demonstrated in xenograft models and in some clinical trials. This chapter provides a discussion of the evolution of CAR-T therapies to enable targeting specific aspects of the TME.
嵌合抗原受体 T (CAR-T) 细胞疗法极大地改变了癌症治疗。FDA 批准了两种 CAR-T 细胞产品,用于治疗其他情况下无法治愈的难治性 B 细胞急性淋巴细胞白血病 (B-ALL) 和侵袭性 B 细胞非霍奇金淋巴瘤,确立了这种治疗作为一种有效的免疫疗法选择。为了将 CAR-T 疗法扩展到各种肿瘤,竞争正在激烈进行。然而,实体器官癌症的反应率迄今为止一直不足,部分原因是肿瘤微环境 (TME) 带来的挑战。TME 是一个复杂的结构,其作用是维持肿瘤的持续存在和增殖,并支持其逃避免疫监视。它存在几个障碍,如抑制性免疫检查点蛋白、免疫抑制细胞、细胞因子、趋化因子、基质因子和不良代谢途径。CAR 结构和 CAR-T 疗法已经发展到克服这些障碍,我们现在有几种新型 CAR,在异种移植模型和一些临床试验中显示出了改善的抗肿瘤活性。本章讨论了 CAR-T 疗法的发展,以实现针对 TME 特定方面的靶向治疗。
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