Journal
ONCOGENE
Volume 40, Issue 2, Pages 421-435Publisher
SPRINGERNATURE
DOI: 10.1038/s41388-020-01501-x
Keywords
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Funding
- Swedish Cancer Society [CAN2016/315]
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Despite the high rates of complete remission achieved through CAR T cell therapy, the efficacy of this approach is limited by dysfunctional CAR T cells, which can be improved through modifications to enhance antitumor functions and lifespan. Research is ongoing on blocking exhaustion and senescence in CAR T cells to boost potency in adoptive cell transfer therapies.
In spite of high rates of complete remission following chimeric antigen receptor (CAR) T cell therapy, the efficacy of this approach is limited by generation of dysfunctional CAR T cells in vivo, conceivably induced by immunosuppressive tumor microenvironment (TME) and excessive antigen exposure. Exhaustion and senescence are two critical dysfunctional states that impose a pivotal hurdle for successful CAR T cell therapies. Recently, modified CAR T cells with an exhaustion-resistant phenotype have shown superior antitumor functions and prolonged lifespan. In addition, several studies have indicated the feasibility of senescence delay in CAR T cells. Here, we review the latest reports regarding blockade of CAR T cell exhaustion and senescence with a particular focus on the exhaustion-inducing pathways. Subsequently, we describe what potential these latest insights offer for boosting the potency of adoptive cell transfer (ACT) therapies involving CAR T cells. Furthermore, we discuss how induction of costimulation, cytokine exposure, and TME modulation can impact on CAR T cell efficacy and persistence, while potential safety issues associated with reinvigorated CAR T cells will also be addressed.
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