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Toxicity and management in CAR T-cell therapy

2016; Elsevier BV; Volume: 3; Linguagem: Inglês

10.1038/mto.2016.11

2372-7705

Challice L. Bonifant, Hollie J. Jackson, Renier J. Brentjens, Kevin J. Curran,

Viral Infectious Diseases and Gene Expression in Insects

T cells can be genetically modified to target tumors through the expression of a chimeric antigen receptor (CAR). Most notably, CAR T cells have demonstrated clinical efficacy in hematologic malignancies with more modest responses when targeting solid tumors. However, CAR T cells also have the capacity to elicit expected and unexpected toxicities including: cytokine release syndrome, neurologic toxicity, "on target/off tumor" recognition, and anaphylaxis. Theoretical toxicities including clonal expansion secondary to insertional oncogenesis, graft versus host disease, and off-target antigen recognition have not been clinically evident. Abrogating toxicity has become a critical step in the successful application of this emerging technology. To this end, we review the reported and theoretical toxicities of CAR T cells and their management.