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CAR-T Cell Therapy: the Efficacy and Toxicity Balance

  • CART and immunotherapy (M Ruella and P Hanley, Section Editors)
  • Published:
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Abstract

Purpose of Review

Chimeric antigen receptor (CAR) T cell therapy is an immunotherapy that has resulted in tremendous progress in the treatment of patients with B cell malignancies. However, the remarkable efficacy of therapy is not without significant safety concerns. Herein, we will review the unique and potentially life-threatening toxicities associated with CAR-T cell therapy and their association with treatment efficacy.

Recent Findings

Currently, CAR-T cell therapy is approved for the treatment of B cell relapsed or refractory leukemia and lymphoma, and most recently, multiple myeloma (MM). In these different diseases, it has led to excellent complete and overall response rates depending on the patient population and therapy. Despite promising efficacy, CAR-T cell therapy is associated with significant side effects; the two most notable toxicities are cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). The treatment of CAR-T-induced toxicity is supportive; however, as higher-grade adverse events occur, toxicity-directed therapy with tocilizumab, an IL-6 receptor antibody, and steroids is standard practice. Overall, a careful risk–benefit balance exists between the efficacy and toxicities of therapies. The challenge lies in the underlying pathophysiology of CAR-T-related toxicity which relies upon the activation of CAR-T cells.

Summary

Some degree of toxicity is expected to achieve an effective response to therapy, and certain aspects of treatment are also associated with toxicity. As progress is made in the investigation and approval of new CARs, novel toxicity-directed therapies and toxicity-limited constructs will be the focus of attention.

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Data Availability

This review article does not present any original unpublished data. All data presented is associated with the corresponding reference.

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Authors and Affiliations

  1. Department of Medicine, Mayo Clinic, Rochester, MN, USA

    Karan L. Chohan

  2. T Cell Engineering, Mayo Clinic, Rochester, MN, USA

    Elizabeth L. Siegler & Saad S. Kenderian

  3. Division of Hematology, Mayo Clinic, Rochester, MN, USA

    Elizabeth L. Siegler & Saad S. Kenderian

  4. Department of Molecular Medicine, Mayo Clinic, Rochester, MN, USA

    Saad S. Kenderian

  5. Department of Immunology, Mayo Clinic, Rochester, MN, USA

    Saad S. Kenderian

  6. Department of Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, 200 1st ST SW, Rochester, MN, 55902, USA

    Saad S. Kenderian

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K. L. C, S. S.K; wrote the initial manuscript: E. L. S contributed to the writing and editing of the final manuscript. All authors approved the submitted version.

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Correspondence to Saad S. Kenderian.

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SSK is inventor on patents in the CART cell field that are licensed to Novartis (through an agreement between Mayo Clinic, University of Pennsylvania, and Novartis), Humanigen (through Mayo Clinic), Mettaforge (through Mayo Clinic), MustangBio (through Mayo Clinic), and Sendero (through Mayo Clinic). SSK has received funding from Novartis, Kite/Gilead, Juno/BMS, Lentigen, Humanigen, Tolero, Morphosys, Sunesis, and Viracta, and LeahLabs. SSK has participated in scientific advisory board meetings with Kite/Gilead, Novartis, BMS, CapstanBio, Luminary therapeutics, and Humanigen. SSK has participated in DSMB meetings with Humanigen. SSK has participated in consulting activities with Novartis, Torque, CapstanBio, Luminary therapeutics, and Calibr. SSK hold equity in Life Engine, Inc. and Leahlabs. KLC and ELS have no conflicts to report.

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Chohan, K.L., Siegler, E.L. & Kenderian, S.S. CAR-T Cell Therapy: the Efficacy and Toxicity Balance. Curr Hematol Malig Rep 18, 9–18 (2023). https://doi.org/10.1007/s11899-023-00687-7

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