Overhauling CAR T Cells to Improve Efficacy, Safety and Cost

Gene therapy is now surpassing 30 years of clinical experience and in that time a variety of approaches has been applied for the treatment of a wide range of pathologies. While the promise of gene therapy was over-stated in the 1990’s, the following decades were met with polar extremes between demonstrable success and devastating setbacks. Currently, the field of gene therapy is enjoying the rewards of overcoming the hurdles that come with turning new ideas into safe and reliable treatments, including for cancer. Among these modalities, the modification of T cells with chimeric antigen receptors (CAR-T cells) has met with clear success and holds great promise for the future treatment of cancer. We detail a series of considerations for the improvement of the CAR-T cell approach, including the design of the CAR, routes of gene transfer, introduction of CARs in natural killer and other cell types, combining the CAR approach with checkpoint blockade or oncolytic viruses, improving pre-clinical models as well as means for reducing cost and, thus, making this technology more widely available. While CAR-T cells serve as a prime example of translating novel ideas into effective treatments, certainly the lessons learned will serve to accelerate the current and future development of gene therapy drugs.

Anti-CD19 Chimeric Antigen Receptor T Cell Therapies: Harnessing the Power of the Immune System to Fight Diffuse Large B Cell Lymphoma

PURPOSE OF REVIEW

This article will review the use of anti-CD19 CAR-T therapy used in relapsed/refractory diffuse large B cell lymphoma.

RECENT FINDINGS

The clinical outcomes, safety analysis, and other relevant considerations will be discussed with an emphasis on the most recently published data regarding the ZUMA-1, JULIET, and TRANSCEND NHL-001 trials. Anti-CD19 CAR-T therapy is an exciting new therapy now approved and available to patients with relapsed/refractory diffuse large B cell lymphoma. Secondary to the increasing success and availability of these products, caregivers should expect to become familiar with the indications, toxicity, and limitations of these treatment options and when patients should be considered for referral.