Last Updated on November 27, 2025 by Bilal Hasdemir
At Liv Hospital, we lead in cancer treatment with CAR T cell therapies. These therapies give new hope to patients globally. CAR T cell therapy is a new immune cell therapy. It makes a patient’s T cells attack cancer cells by changing their genes.
New CAR T cell technology has shown great success. It has given patients up to 70-90% durable remission in some leukemia cases. We aim to share the science behind this treatment. It could change how we fight cancer.
Key Takeaways
- CAR T cell therapy is a groundbreaking treatment that harnesses the power of a patient’s immune system to fight cancer.
- Genetic engineering enables T cells to recognize and target specific cancer cells.
- Durable remission rates of up to 70-90% have been achieved in certain leukemia cases.
- Liv Hospital is dedicated to providing world-class care and support for international patients seeking CAR T cell therapies.
- Our team is committed to making complex medical concepts accessible to patients worldwide.
The Fundamentals of Chimeric Antigen Receptor CAR T Cells
CAR T cell technology has changed the game in cancer treatment. It gives hope to those with specific cancers. This method makes a patient’s T cells better at fighting cancer cells.
Definition and Basic Concepts
Chimeric Antigen Receptor (CAR) T cell therapy is a new way to fight cancer. It starts by taking a patient’s T cells. Then, it makes these cells better at finding and killing cancer cells.
This therapy works by boosting the body’s immune system against cancer. It does this by changing T cells to recognize cancer cells. This way, T cells can attack cancer cells without needing to see them first.
Historical Development of CAR T Cell Technology
The journey of CAR T cell technology began with genetic engineering and immunology. The first CARs were made in the 1990s. Later, they got better with more parts added to help T cells work better.
The first trials of CAR T cell therapy started in the early 2000s. Soon, the FDA approved CAR T cell treatments. For example, tisagenlecleucel (Kymriah) and axicabtagene ciloleucel (Yescarta) are now approved for some cancers.
Today, CAR T cell technology keeps getting better. New versions and allogeneic CAR T cells are being explored. The recent buyout of TC BioPharm by CytoMed Therapeutics shows how much interest there is in this field.
The Science Behind CAR-T Cell Engineering
At the core of CAR-T cell therapy is a detailed genetic engineering method. It makes T cells spot and destroy cancer cells with great accuracy. This method changes a patient’s T cells to carry a chimeric antigen receptor (CAR). This CAR finds a specific antigen on cancer cells.
Genetic Modification Process
The process of making CAR-T cells is complex and involves several steps. First, T cells are taken from the patient’s blood or tumor. Then, these T cells are genetically altered to have the CAR. Viral vectors, like lentiviral or retroviral, carry the CAR gene into the T cells.
The CAR gene makes the T cells recognize and attach to specific cancer cell antigens. After creating the CAR-T cells, they are grown in number. They also go through quality checks before being given back to the patient.
Components of Chimeric Antigen Receptors
Chimeric antigen receptors are made to find specific cancer cell antigens. A CAR has several parts:
| Component | Function |
|---|---|
| Antigen Recognition Domain | Recognizes and binds to specific antigens on cancer cells |
| Transmembrane Domain | Anchors the CAR in the T cell membrane |
| Intracellular Signaling Domains | Activates T cell upon antigen binding, triggering T cell proliferation and cytotoxic activity |
CAR-T cell therapies have shown great success in treating blood cancers. This shows how important it is to know about CAR T cell engineering. By changing T cells to have CARs, we can use the body’s immune system to fight cancer better.
How CAR-T Therapies Target Cancer Cells
CAR-T therapies are a new way to fight cancer. They make T cells attack cancer cells. This is done by changing T cells to find and kill cancer cells better.
Mechanism of Action
First, T cells are taken from the patient. Then, they are changed to find and kill cancer cells. After being changed, these T cells go back into the patient. They then find and destroy cancer cells.
CAR-T cell therapy works in several ways:
- It recognizes cancer cells through the CAR.
- It activates and grows more CAR-T cells.
- It kills cancer cells.
Specificity and Targeting Capabilities
The CAR-T therapy’s success depends on the CAR design and the target antigen. Scientists are always improving CAR-T therapy to make it safer and more effective.
Research is ongoing to make CAR-T therapy work for more cancers. The FDA has approved some CAR-T therapies for leukemia and lymphoma.
The table below shows how CAR-T therapies target cancer cells and their impact on treatment.
| Target Antigen | Cancer Type | Specificity | Efficacy |
|---|---|---|---|
| CD19 | Leukemia, Lymphoma | High | High remission rates |
| BCMA | Multiple Myeloma | High | Promising response rates |
| Other antigens | Various cancers | Varies | Ongoing research |
As CAR-T therapy improves, we expect it to help more patients with different cancers.
The CAR-T Treatment Process
Understanding the CAR-T treatment process is key for those considering it. It includes several important steps, from collecting T cells to infusing CAR-T cells.
Patient T Cell Collection (Leukapheresis)
The first step is collecting T cells from the patient’s blood. This is done through a procedure called leukapheresis. The blood is drawn, and the T cells are separated from other components. The rest of the blood is then returned to the patient.
This process takes several hours and is usually done outside the hospital.
Laboratory Modification of T Cells
After collecting T cells, they go to a lab for genetic modification. They are given a gene that helps them target cancer cells better. This is done using a viral vector.
Expansion and Quality Control
The modified T cells are then grown in number. This can take days to weeks. They are checked to make sure they can target cancer cells well and are safe.
Lymphodepletion and CAR T Cell Infusion
Before getting the CAR-T cells, patients have lymphodepletion chemotherapy. This treatment reduces the number of lymphocytes in the body. It helps the CAR-T cells work better.
After this, the CAR-T cells are given back to the patient. This is done through an intravenous line. The infusion is quick, but patients are watched closely for any bad reactions.
| Step | Description | Duration |
|---|---|---|
| Leukapheresis | Collection of T cells from the patient’s blood | Several hours |
| Laboratory Modification | Genetic modification of T cells to express CAR | Several days to weeks |
| Expansion and Quality Control | Expansion of CAR-T cells and quality checks | Several days to weeks |
| Lymphodepletion | Chemotherapy to deplete existing lymphocytes | Varies depending on regimen |
| CAR T Cell Infusion | Infusion of CAR-T cells back into the patient | Relatively quick |
Each step in the CAR-T treatment process is vital for its success. By understanding these steps, patients and their families can better follow the treatment journey. They can see the complexity and innovation of CAR-T cell therapy.
Types of CAR T Cell Therapies and Approaches
CAR T cell therapies have grown from simple designs to complex treatments. Each new generation aims to tackle different challenges in fighting cancer. This progress is helping to make cancer treatment more effective.
First to Fifth Generation CAR Designs
Over time, CAR T cell technology has improved a lot. First-generation CARs were the first step, starting with basic antigen recognition. Later generations added more features to make treatments better and safer.
Second-generation CARs added a costimulatory domain, boosting T cell growth and survival. Third-generation CARs included even more domains to mimic natural T cell activation. Fourth-generation CARs, or TRUCKs, release cytokines to enhance the fight against tumors. The latest, fifth-generation CARs, have added safety features like suicide genes.
Target Antigens in Different Cancers
CAR T cells can target various antigens on cancer cells. The right target is key for effective treatment. For example, CD19 is used for B cell cancers, while BCMA is explored for multiple myeloma.
| Cancer Type | Target Antigen |
|---|---|
| B Cell Leukemia/Lymphoma | CD19 |
| Multiple Myeloma | BCMA |
| Acute Lymphoblastic Leukemia (ALL) | CD19, CD22 |
Autologous vs. Allogeneic CAR T Cells
CAR T cell therapies come in two types: autologous and allogeneic. Autologous CAR T cells use the patient’s own T cells, making treatment more personal. But, it can be limited by the quality and quantity of T cells.
Recent collaborations show growing interest in allogeneic CAR T cells. Allogeneic CAR T cells come from healthy donors, aiming for a quicker, more affordable solution. But, managing graft-versus-host disease is a big challenge.
As CAR T cell therapy advances, understanding these differences is key. It helps choose the best treatment for each patient.
Clinical Applications and FDA Approvals
CAR T cell therapies have made big strides in treating blood cancers. They are now approved for leukemia, lymphoma, and multiple myeloma. This is a big win for patients.
CAR T Cell Therapy for Leukemia
CAR T cell therapy is a game-changer for some leukemia patients. Tisagenlecleucel and axicabtagene ciloleucel are two therapies approved by the FDA. They work well against certain types of leukemia and lymphoma.
These therapies offer new hope to those with few treatment options. Clinical trials show better response rates and longer remissions.
CAR T Cell Therapy for Lymphoma
CAR T cell therapies are also promising for lymphoma treatment. Axicabtagene ciloleucel and tisagenlecleucel are FDA-approved for certain lymphomas. They are a valuable option for those who haven’t responded to other treatments.
These therapies are showing good results. Patients are experiencing better response rates and longer survival times.
CAR T Cell Therapy for Multiple Myeloma
Researchers are also exploring CAR T cell therapies for multiple myeloma. While there are fewer approvals here, trials are showing promise.
Idecabtagene vicleucel is a CAR T cell therapy approved for multiple myeloma. We expect more progress as research continues.
Timeline of CAR T Therapy FDA Approvals
The FDA has approved CAR T cell therapies at key moments. The first was approved in 2017, with more approvals coming after.
- 2017: Tisagenlecleucel approved for relapsed or refractory B-cell precursor ALL.
- 2018: Axicabtagene ciloleucel approved for relapsed or refractory DLBCL.
- 2020: Idecabtagene vicleucel approved for relapsed or refractory multiple myeloma.
We’re watching for more CAR T cell therapies and their FDA approvals. This will give patients more treatment options for blood cancers.
Efficacy and Outcomes of CAR T Immunotherapy
It’s important to check how well CAR T immunotherapy works in treating cancer. We need to look at the results from different places to understand its value.
Response Rates in Different Cancer Types
CAR T cell therapies work well in some cancers, like blood cancers. For example, in a certain blood cancer called ALL, it helps 70% to 90% of patients get better. It also shows promise in another cancer, DLBCL, with up to 50% of patients responding well.
But, how well it works varies by cancer type. This shows we need to make CAR T cell therapies fit each cancer’s needs. Researchers are working hard to make these treatments better and find out who will benefit most.
Durability of Remissions
How long the benefits of CAR T cell therapy last is key. Some patients stay cancer-free for years, with up to 40% of them staying disease-free for two years or more. This is because the CAR T cells keep fighting cancer cells.
But, not everyone stays cancer-free for long. Things like the type of cancer, past treatments, and side effects can affect how long the benefits last.
Factors Affecting Treatment Success
Many things can change how well CAR T cell therapy works. For example, who gets the treatment and what kind of cancer they have matters. Also, having other health issues can affect the outcome.
Managing side effects like CRS and neurotoxicity is also key. Improving care for these issues can help more patients do well. As CAR T immunotherapy gets better, knowing what makes it work will help treat more people.
Challenges and Considerations of CAR-T Cell Treatment
CAR-T cell therapy has shown great promise, but it faces significant challenges. Understanding and managing its side effects and logistical issues are key to better patient outcomes.
Cytokine Release Syndrome (CRS)
Cytokine release syndrome is a serious side effect of CAR-T cell therapy. It happens when T cells release a lot of cytokines, causing inflammation. Early recognition and management of CRS are critical to prevent severe complications.
“The management of CRS involves the use of anti-IL-6 receptor antibodies, such as tocilizumab, and corticosteroids in more severe cases,” as noted in recent clinical guidelines. Effective management strategies are essential to mitigate the risks associated with CRS.
Neurotoxicity
Neurotoxicity is another significant side effect of CAR-T cell therapy. It can cause confusion, delirium, and in severe cases, cerebral edema. The exact mechanisms behind CAR-T cell-related neurotoxicity are not fully understood yet. Close monitoring and supportive care are key to managing this condition.
Research into the pathophysiology of neurotoxicity is ongoing. Studies suggest that cytokine release and disruption of the blood-brain barrier may play critical roles. Understanding these mechanisms will be vital in developing more effective treatments.
B Cell Aplasia
B cell aplasia is a consequence of targeting CD19 in CAR-T cell therapy for B cell malignancies. While effective in eliminating cancerous B cells, it can also deplete normal B cells, leading to hypogammaglobulinemia. Long-term management may involve immunoglobulin replacement therapy to mitigate the risk of infections.
Accessibility and Cost Considerations
The high cost and complexity of CAR-T cell therapy pose significant barriers to accessibility. The process involves personalized manufacturing, which is resource-intensive and expensive. Addressing these challenges will require innovative solutions, including improved manufacturing processes and reimbursement policies that make this life-saving treatment more accessible to those who need it.
As we continue to advance in the field of CAR-T cell therapy, it is essential that we address these challenges head-on. By doing so, we can work towards making this revolutionary treatment more effective, safer, and more accessible to patients worldwide.
Conclusion
Chimeric antigen receptor CAR T cells are a major leap in cancer treatment. They have shown great promise in fighting cancer cells. This gives hope to those with leukemia, lymphoma, and multiple myeloma.
CAR-T therapies are a big step forward in using the body’s immune cells to fight cancer. They have shown strong results in clinical trials. This makes them a personalized and effective way to treat cancer.
Even though there are challenges like cytokine release syndrome and neurotoxicity, research is ongoing. The goal is to make CAR T cell therapy safer and more effective. We are dedicated to providing top-notch care to patients from around the world. This includes CAR-T therapies and other immune cell therapies.
FAQ
What are CAR T cells and how do they work?
CAR T cells are a type of immunotherapy. They are T cells from the patient that are genetically modified. This modification lets them recognize and attack cancer cells.
What is the process of CAR-T treatment?
The process starts with collecting T cells from the patient. These cells are then modified in a lab to target cancer. Before returning the cells to the patient, chemotherapy is given to prepare the immune system.
What are the different types of CAR T cell therapies?
CAR T cell therapies have evolved over time. They range from first to fifth generation, each with new features. There are also autologous and allogeneic CAR T cells, each with its own benefits and challenges.
What are the approved uses of CAR T cell therapies?
CAR T cell therapies are approved for some types of leukemia, lymphoma, and multiple myeloma. The FDA has given specific approvals, marking important milestones in their development.
What are the possible side effects of CAR-T cell treatment?
Side effects can include cytokine release syndrome, neurotoxicity, and B cell aplasia. We closely monitor patients for these and manage them to ensure the best outcomes.
How effective are CAR T cell therapies?
CAR T cell therapies have shown great success in treating certain cancers. They can lead to long-lasting remissions, but results vary. We are always looking for ways to improve their effectiveness.
What is the future of CAR T cell research and development?
CAR T cell research is growing fast. We are studying ways to make these therapies safer and more effective. Our goal is to provide the best care to patients from around the world.
Are CAR T cell therapies available worldwide?
CAR T cell therapies are approved in many countries, but availability can vary. We aim to make these treatments accessible to patients globally, despite the challenges.
How do CAR T cell therapies compare to traditional cancer treatments?
CAR T cell therapies are a major step forward in cancer treatment. They use the patient’s immune system to fight cancer, unlike traditional treatments. This approach offers a potentially curative option for some cancers.
What is the role of chimeric antigen receptor technology in CAR T cell therapies?
Chimeric antigen receptor technology is key to CAR T cell therapies. It allows T cells to find and destroy cancer cells. We are working to make this technology even better and safer.
References
- National Cancer Institute. CAR T cells in cancer treatment. https://www.cancer.gov/about-cancer/treatment/research/car-t-cells
- Zhang C, et al. Chimeric Antigen Receptor (CAR) T‑Cell Therapy. StatPearls (NCBI Bookshelf). NBK537294. https://www.ncbi.nlm.nih.gov/books/NBK537294/ (NCBI)
- Feins S, Kong W, Williams EF, Milone MC, Fraietta JA. An introduction to chimeric antigen receptor (CAR) T‑cell immunotherapy for human cancer. Am J Hematol. 2019;94(S1):S3‑S9. doi:10.1002/ajh.25418. https://onlinelibrary.wiley.com/doi/full/10.1002/ajh.25418 (Wiley Online Library)
- Sterner RC, Sterner RM. CAR‑T cell therapy: current limitations and potential strategies. Blood Cancer Journal. 2021;11:69. https://www.nature.com/articles/s41408-021-00459-7
- Feins S, et al. An introduction to chimeric antigen receptor (CAR) T‑cell immunotherapy for human cancer. Am J Hematol. 2019;94(S1):S3‑S9. (Review) https://pubmed.ncbi.nlm.nih.gov/30680780/ (PubMed)
