For years, cancer treatment was dominated by chemotherapy, radiation therapy, and stem cell transplantation. New insights into genetic characteristics of leukemic cells have initiated the development of the chimeric antigen receptor (CAR) T-cell therapy. This type of adoptive cell immunotherapy has been a breakthrough in the treatment of aggressive B-cell lymphoma and B-cell precursor acute lymphoblastic leukemia. In August 2018, the European Commission has approved the first CAR T-cell products – tisagenlecleucel (Kymriah®, Novartis) and axicabtagene ciloleucel (Yescarta®, Gilead) – for hematological neoplasms in Europe. As CAR T cells are a living drug, its benefits can last for many years. The administration of CAR T cells is a complex and costly endeavor involving cell manufacture, shipping of apheresis products, and management of novel and severe adverse reactions. The most common toxicities observed after CAR T-cell therapy are cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome. Current research focuses on improved safety and efficacy in hematological malignancies as well as the translation of CAR T-cell therapy to solid tumors. This review covers the development and current status of CAR T-cell therapy in a clinical setting with focus on challenges and future opportunities.

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嵌合抗原受体 T 细胞：一场彻底改变癌症治疗的竞赛

多年来，癌症治疗主要是化学疗法、放射疗法和干细胞移植。对白血病细胞遗传特征的新见解已经启动了嵌合抗原受体 (CAR) T 细胞疗法的开发。这种类型的过继细胞免疫疗法在侵袭性 B 细胞淋巴瘤和 B 细胞前体急性淋巴细胞白血病的治疗中取得了突破。2018 年 8 月，欧盟委员会批准了首个 CAR T 细胞产品——tisagenlecleucel（Kymriah®，诺华）和 axicabtagene ciloleucel（Yescarta®，吉利德）——用于欧洲的血液肿瘤。由于 CAR T 细胞是一种活的药物，它的好处可以持续很多年。CAR T 细胞的管理是一项复杂且昂贵的工作，涉及细胞制造、血液分离产品的运输、和管理新的和严重的不良反应。CAR T 细胞治疗后观察到的最常见毒性是细胞因子释放综合征和免疫效应细胞相关神经毒性综合征。目前的研究重点是提高血液系统恶性肿瘤的安全性和有效性，以及将 CAR T 细胞疗法转化为实体瘤。本综述涵盖了临床环境中 CAR T 细胞疗法的发展和现状，重点关注挑战和未来机遇。