Chan Justine Tin Nok, Henley-Waters James, Kayhanian Saeed
Fitzwilliam College, University of Cambridge, Cambridge, UK.
School of Clinical Medicine, University of Cambridge, Cambridge, UK.
Neurooncol Adv. 2025 Jun 3;7(1):vdaf115. doi: 10.1093/noajnl/vdaf115. eCollection 2025 Jan-Dec.
BACKGROUND: Glioblastoma is a malignant brain tumor with poor outcomes. Chimeric antigen receptor-T (CAR-T)-cell therapy is a possible new intervention in solid tumors using T cells engineered with cancer-specific antigens. This approach is challenged by limited T-cell trafficking to solid tumors, the immunosuppressive tumor microenvironment, and glioblastoma-specific uncertainties. Several first-in-human trials have now trialed CAR-T therapy for glioblastoma. We undertake a systematic review of these Phase I trials to draw early lessons about the safety and feasibility of this approach. METHODS: Systematic review of all published clinical trials using CAR-T therapy for glioblastoma on July 31, 2024, from 5 databases. RESULTS: Thirteen published studies of Phase I trials of CAR-T therapy for glioblastoma ( = 128 patients). Six molecular targets were used, most commonly EGFR family (7 studies) and IL13a2 (4 studies). There were 141 severe adverse effects (SAEs) and 2 dose-limiting toxicities. SAEs were most commonly neurological or hematological, and most commonly observed with doses over 1 × 10 cells. Routes of delivery included intravenous, intraventricular, intracavitary, and intratumoral. Several participants across trials demonstrated transient responses, but efficacy across trials was difficult to compare, given heterogeneous reporting of outcomes. CONCLUSIONS: Several CAR-T strategies have now been trialed preliminarily for glioblastoma. There appears to be a signal of efficacy, with 56 of 128 reported patients demonstrating at least some measure of response. Central delivery of CAR-T cells appears safe with doses up to 2.5 × 10 cells well-tolerated. Subsequent CAR-T trials should standardize reporting of outcomes for better comparison across trials.
背景:胶质母细胞瘤是一种预后较差的恶性脑肿瘤。嵌合抗原受体T细胞(CAR-T)疗法是一种利用经癌症特异性抗原工程改造的T细胞对实体瘤进行干预的可能新方法。这种方法受到T细胞向实体瘤迁移受限、免疫抑制性肿瘤微环境以及胶质母细胞瘤特异性不确定性的挑战。目前已有多项首次人体试验对胶质母细胞瘤的CAR-T疗法进行了试验。我们对这些I期试验进行系统评价,以汲取有关该方法安全性和可行性的早期经验教训。 方法:于2024年7月31日对来自5个数据库的所有已发表的使用CAR-T疗法治疗胶质母细胞瘤的临床试验进行系统评价。 结果:发表了13项关于胶质母细胞瘤CAR-T疗法I期试验的研究(n = 128例患者)。使用了6种分子靶点,最常见的是表皮生长因子受体(EGFR)家族(7项研究)和白细胞介素13α2(IL13a2,4项研究)。有141例严重不良反应(SAE)和2例剂量限制性毒性反应。SAE最常见于神经或血液系统,最常在剂量超过1×10⁹细胞时观察到。给药途径包括静脉内、脑室内、腔内和瘤内。多项试验中的一些参与者表现出短暂反应,但鉴于结果报告的异质性,各试验间的疗效难以比较。 结论:目前已对几种CAR-T策略用于胶质母细胞瘤进行了初步试验。似乎有疗效信号,128例报告患者中有56例至少表现出某种程度的反应。CAR-T细胞的中枢给药似乎是安全的,高达2.5×10⁹细胞的剂量耐受性良好。后续的CAR-T试验应规范结果报告,以便在各试验间进行更好的比较。
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