Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
Immune Dysregulation Frontier Program, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
Semin Immunopathol. 2024 Jul 16;46(3-4):5. doi: 10.1007/s00281-024-01013-w.
The advent of chimeric antigen receptor T cells (CAR-T) has been a paradigm shift in cancer immunotherapeutics, with remarkable outcomes reported for a growing catalog of malignancies. While CAR-T are highly effective in multiple diseases, salvaging patients who were considered incurable, they have unique toxicities which can be life-threatening. Understanding the biology and risk factors for these toxicities has led to targeted treatment approaches which can mitigate them successfully. The three toxicities of particular interest are cytokine release syndrome (CRS), immune effector cell-associated neurotoxicity syndrome (ICANS), and immune effector cell-associated hemophagocytic lymphohistiocytosis (HLH)-like syndrome (IEC-HS). Each of these is characterized by cytokine storm and hyperinflammation; however, they differ mechanistically with regard to the cytokines and immune cells that drive the pathophysiology. We summarize the current state of the field of CAR-T-associated toxicities, focusing on underlying biology and how this informs toxicity management and prevention. We also highlight several emerging agents showing promise in preclinical models and the clinic. Many of these established and emerging agents do not appear to impact the anti-tumor function of CAR-T, opening the door to additional and wider CAR-T applications.
嵌合抗原受体 T 细胞 (CAR-T) 的出现是癌症免疫治疗的一个范式转变,越来越多的恶性肿瘤报告了显著的结果。虽然 CAR-T 在多种疾病中非常有效,挽救了被认为无法治愈的患者,但它们具有独特的毒性,可能危及生命。了解这些毒性的生物学和风险因素导致了针对这些毒性的靶向治疗方法,可以成功地减轻它们。特别值得关注的三种毒性是细胞因子释放综合征 (CRS)、免疫效应细胞相关神经毒性综合征 (ICANS) 和免疫效应细胞相关噬血细胞淋巴组织细胞增生症样综合征 (IEC-HS)。这些毒性都以细胞因子风暴和炎症反应过度为特征;然而,它们在驱动病理生理学的细胞因子和免疫细胞方面在机制上有所不同。我们总结了 CAR-T 相关毒性领域的现状,重点介绍了潜在的生物学以及这如何为毒性管理和预防提供信息。我们还强调了几种在临床前模型和临床中显示出前景的新兴药物。许多这些已确立和新兴的药物似乎不会影响 CAR-T 的抗肿瘤功能,为更多和更广泛的 CAR-T 应用打开了大门。
Semin Immunopathol. 2024-7-16
Mol Ther. 2024-9-4
Transplant Cell Ther. 2025-4-25
Inn Med (Heidelb). 2025-7-8
Ann Med Surg (Lond). 2025-7-18
Bone Marrow Transplant. 2025-6-19
Front Pharmacol. 2025-5-8
Signal Transduct Target Ther. 2025-4-16
Blood. 2023-10-5
Nat Rev Clin Oncol. 2023-6