CARTcellsterapi

CARTcellsterapi, often referred to as CAR-T cell therapy, is a form of adoptive cell transfer immunotherapy in which a patient’s T cells are collected, genetically modified to express chimeric antigen receptors (CARs) that recognize specific tumor-associated antigens, and then re-infused to attack cancer cells. It is primarily used for certain hematologic malignancies and is being explored for solid tumors as well.

Mechanism and generations: CARs combine an antigen-binding domain derived from antibodies with T cell signaling domains. When the CAR engages its target antigen, the modified T cells become activated, proliferate, and kill tumor cells while releasing cytokines. Earlier generations lacked certain co-stimulatory signals; newer generations include co-stimulatory domains such as CD28 or 4-1BB to enhance activation, expansion, and persistence of the CAR-T cells.

Process and indications: The therapy begins with leukapheresis to collect T cells, followed by genetic modification and expansion in a manufacturing facility. After conditioning chemotherapy, the CAR-T product is infused back into the patient. Most approved CAR-T therapies target CD19 or other B-cell–specific antigens and are approved for various B-cell malignancies, including acute lymphoblastic leukemia, certain non-Hodgkin lymphomas, and multiple myeloma (BCMA-targeted products).

Safety and limitations: The most common and serious adverse effects are cytokine release syndrome (CRS) and neurotoxicity (ICANS), along with cytopenias, infections, and hypogammaglobulinemia. Management may involve tocilizumab, corticosteroids, and supportive care. Limitations include antigen escape, manufacturing complexity and cost, delayed access, and relatively limited success in solid tumors.

Research directions: Ongoing work aims to improve safety and efficacy with dual or multi-target CARs, off-the-shelf allogeneic CAR-T products, regulatory safety switches, combination therapies, and strategies to broaden application to solid tumors.