Terry Fox Laboratory, BC Cancer Research Institute, Vancouver, BC, Canada.
Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
Front Immunol. 2021 Feb 10;11:618387. doi: 10.3389/fimmu.2020.618387. eCollection 2020.
T-cells genetically engineered to express a chimeric antigen receptor (CAR) have shown remarkable results in patients with B-cell malignancies, including B-cell acute lymphoblastic leukemia, diffuse large B-cell lymphoma, and mantle cell lymphoma, with some promising efficacy in patients with multiple myeloma. However, the efficacy of CAR T-cell therapy is still hampered by local immunosuppression and significant toxicities, notably cytokine release syndrome (CRS) and neurotoxicity. The tumor microenvironment (TME) has been identified to play a major role in preventing durable responses to immunotherapy in both solid and hematologic malignancies, with this role exaggerated in solid tumors. The TME comprises a diverse set of components, including a heterogeneous population of various cells and acellular elements that collectively contribute towards the interplay of pro-immune and immunosuppressive signaling. In particular, macrophages, myeloid-derived suppressor cells, regulatory T-cells, and cell-free factors such as cytokines are major contributors to local immunosuppression in the TME of patients treated with CAR T-cells. In order to create a more favorable niche for CAR T-cell function, armored CAR T-cells and other combinatorial approaches are being explored for potential improved outcomes compared to conventional CAR T-cell products. While these strategies may potentiate CAR T-cell function and efficacy, they may paradoxically increase the risk of adverse events due to increased pro-inflammatory signaling. Herein, we discuss the mechanisms by which the TME antagonizes CAR T-cells and how innovative immunotherapy strategies are being developed to address this roadblock. Furthermore, we offer perspective on how these novel approaches may affect the risk of adverse events, in order to identify ways to overcome these barriers and expand the clinical benefits of this treatment modality in patients with diverse cancers. Precise immunomodulation to allow for improved tumor control while simultaneously mitigating the toxicities seen with current generation CAR T-cells is integral for the future application of more effective CAR T-cells against other malignancies.
经基因工程改造表达嵌合抗原受体 (CAR) 的 T 细胞在 B 细胞恶性肿瘤患者中显示出显著疗效,包括 B 细胞急性淋巴细胞白血病、弥漫性大 B 细胞淋巴瘤和套细胞淋巴瘤,在多发性骨髓瘤患者中也显示出一定的疗效。然而,CAR T 细胞疗法的疗效仍然受到局部免疫抑制和显著毒性的限制,特别是细胞因子释放综合征 (CRS) 和神经毒性。肿瘤微环境 (TME) 已被确定在防止包括实体瘤和血液恶性肿瘤在内的免疫疗法产生持久反应中起主要作用,在实体瘤中这种作用更为突出。TME 由多种成分组成,包括各种细胞和无细胞成分的异质群体,它们共同促进了促免疫和免疫抑制信号的相互作用。特别是巨噬细胞、髓源性抑制细胞、调节性 T 细胞和细胞因子等无细胞因子是 CAR T 细胞治疗患者 TME 中局部免疫抑制的主要贡献者。为了为 CAR T 细胞的功能创造更有利的环境,正在探索装甲 CAR T 细胞和其他组合方法,以期与传统的 CAR T 细胞产品相比获得更好的结果。虽然这些策略可能增强 CAR T 细胞的功能和疗效,但由于促炎信号的增加,它们可能会增加不良事件的风险,从而产生矛盾。在此,我们讨论了 TME 拮抗 CAR T 细胞的机制,以及如何开发创新性免疫疗法策略来解决这一障碍。此外,我们还提供了对这些新方法如何影响不良事件风险的看法,以确定克服这些障碍并扩大这种治疗模式在不同癌症患者中的临床获益的方法。精确的免疫调节对于改善肿瘤控制同时减轻当前代 CAR T 细胞毒性至关重要,这对于未来应用更有效的 CAR T 细胞治疗其他恶性肿瘤具有重要意义。
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