Center for Translational Research in Onco-Hematology, University of Geneva, Geneva, Switzerland.
Swiss Cancer Center Léman, Lausanne, Switzerland.
Front Immunol. 2021 Mar 3;12:640082. doi: 10.3389/fimmu.2021.640082. eCollection 2021.
Chimeric antigen receptor (CAR) T cell therapy has emerged as one of the major breakthroughs in cancer immunotherapy in the last decade. Outstanding results in hematological malignancies and encouraging pre-clinical anti-tumor activity against a wide range of solid tumors have made CAR T cells one of the most promising fields for cancer therapies. CAR T cell therapy is currently being investigated in solid tumors including glioblastoma (GBM), a tumor for which survival has only modestly improved over the past decades. CAR T cells targeting EGFRvIII, Her2, or IL-13Rα2 have been tested in GBM, but the first clinical trials have shown modest results, potentially due to GBM heterogeneity and to the presence of an immunosuppressive microenvironment. Until now, the use of autologous T cells to manufacture CAR products has been the norm, but this approach has several disadvantages regarding production time, cost, manufacturing delay and dependence on functional fitness of patient T cells, often reduced by the disease or previous therapies. Universal "off-the-shelf," or allogeneic, CAR T cells is an alternative that can potentially overcome these issues, and allow for multiple modifications and CAR combinations to target multiple tumor antigens and avoid tumor escape. Advances in genome editing tools, especially CRISPR/Cas9, might allow overcoming the two main limitations of allogeneic CAR T cells product, i.e., graft-vs.-host disease and host allorejection. Here, we will discuss how allogeneic CAR T cells could allow for multivalent approaches and alteration of the tumor microenvironment, potentially allowing the development of next generation therapies for the treatment of patients with GBM.
嵌合抗原受体 (CAR) T 细胞疗法是过去十年癌症免疫疗法的重大突破之一。在血液恶性肿瘤方面的卓越疗效和针对广泛实体瘤的令人鼓舞的临床前抗肿瘤活性,使 CAR T 细胞成为癌症治疗最有前途的领域之一。CAR T 细胞疗法目前正在包括胶质母细胞瘤 (GBM) 在内的实体瘤中进行研究,而过去几十年中,GBM 的生存率仅略有提高。针对 EGFRvIII、Her2 或 IL-13Rα2 的 CAR T 细胞已在 GBM 中进行了测试,但首次临床试验结果表明疗效有限,这可能是由于 GBM 的异质性和存在免疫抑制微环境所致。到目前为止,使用自体 T 细胞制造 CAR 产品一直是标准做法,但这种方法在生产时间、成本、制造延迟以及对患者 T 细胞功能适应性的依赖方面存在几个缺点,这些缺点常常因疾病或先前的治疗而降低。通用的“现成的”或同种异体 CAR T 细胞是一种替代方法,它可以潜在地克服这些问题,并允许进行多次修饰和 CAR 组合,以靶向多个肿瘤抗原,并避免肿瘤逃逸。基因组编辑工具的进步,特别是 CRISPR/Cas9,可能克服同种异体 CAR T 细胞产品的两个主要限制,即移植物抗宿主病和宿主同种异体排斥。在这里,我们将讨论同种异体 CAR T 细胞如何能够实现多价方法和改变肿瘤微环境,从而有可能为治疗 GBM 患者开发下一代治疗方法。
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