Królikowska Aleksandra, Tarnowski Maciej
Department of Physiology in Health Sciences, Faculty of Health Sciences, Pomeranian Medical University in Szczecin, Szczecin, Poland.
Cancer Immunol Immunother. 2025 Nov 6;74(12):363. doi: 10.1007/s00262-025-04222-w.
Glioblastoma multiforme (GBM) is highly lethal brain tumor with limited benefit from standard treatment, such as surgery, radiotherapy, and chemotherapy. Its location within the central nervous system, together with the blood-brain barrier, and immunosuppressive niche restricts access and efficacy of therapies. This review examines the current progress of the chimeric antigen receptor (CAR) T cell therapy in GBM, emphasizing therapeutically significant target antigens, delivery strategy and innovations designed to improve safety and persistence. Evidence from preclinical research and early phase clinical trials was assessed to identify key antigen, evaluate routes of administration, and summarize next-generation engineering concepts. Clinical experiences demonstrate that locoregional delivery can enhance tumor penetration compared with systemic infusion. Moreover, CAR-T cells engineered to recognize epidermal growth factor receptor variant III, interleukin-13 receptor subunit alpha-2, human epidermal growth factor receptor 2, or disialoganglioside have shown biological activity in GBM. Emerging platforms, such as dual-target CARs, synNotch, and cytokine-releasing "armored" T cells, develop specificity and overcome barriers posed by tumor heterogeneity and immune suppression. CAR-T therapy in GBM has moved beyond proof-of-concept, with encouraging but preliminary signals of efficacy. Future success will require multi-target approaches, integration with modulators of tumor microenvironment, and optimized delivery systems to achieve durable clinical benefit.
多形性胶质母细胞瘤(GBM)是一种极具致死性的脑肿瘤,标准治疗(如手术、放疗和化疗)对其疗效有限。它位于中枢神经系统内,加上血脑屏障和免疫抑制微环境,限制了治疗方法的可及性和疗效。本文综述了嵌合抗原受体(CAR)T细胞疗法在GBM治疗中的当前进展,重点介绍了具有治疗意义的靶抗原、递送策略以及旨在提高安全性和持久性的创新方法。评估了临床前研究和早期临床试验的证据,以确定关键抗原、评估给药途径,并总结下一代工程概念。临床经验表明,与全身输注相比,局部区域递送可增强肿瘤穿透性。此外,经过工程改造以识别表皮生长因子受体变体III、白细胞介素-13受体亚基α-2、人表皮生长因子受体2或双唾液酸神经节苷脂的CAR-T细胞在GBM中已显示出生物学活性。新兴平台,如双靶点CAR、合成Notch和细胞因子释放“武装”T细胞,提高了特异性,并克服了肿瘤异质性和免疫抑制带来的障碍。GBM中的CAR-T疗法已超越概念验证阶段,显示出令人鼓舞但仍属初步的疗效信号。未来的成功将需要多靶点方法、与肿瘤微环境调节剂的整合以及优化的递送系统,以实现持久的临床益处。