CAR T-Cell Therapy in Cancer: Balancing Efficacy with Cardiac Toxicity Concerns

Author(s): Parth Bhargava and Devendra K. Agrawal.

CAR-T therapy (Chimeric antigen receptor T-cell therapy) is a novel and transformative approach to fighting cancer, modulating the immune system involving adoptive cell therapy. In this article, a comprehensive information is provided on the effectiveness of CAR-T therapy in various types of cancers some of which have shown to be particularly challenging cancers to fully eliminate. The clinical effectiveness of CAR-T therapy compared to other traditional methods of cancer treatments such as surgical, radiotherapy, high dose rate (HDR)-brachytherapy, and immunotherapy favors CAR-T cell treatment strategy. The article presents the concept of CAR-T, discuss the structure and function of this novel therapeutic and its efficacy in liquid cancers, and development of therapies in solid cancers. Partial and complete response rates in relation to the CAR-T methodologies on various cancers are critically reviewed with discussion on the durability and overall long-term effects and limitations. Potential role of CAR-T therapies in various cancer treatments is reviewed in conjunction with other therapies and the efficacies and status on the progress of those therapies. Despite the impressive efficacy of CAR-T therapy, it is associated with potentially serious side effects, particularly cardiovascular toxicities that require proper cardiovascular screening prior, during, and after CAR-T therapy. These highlight the standardized modes of monitoring, prevention, and management of the toxicities. The cytokine release storm (CRS) in the pathogenesis of CAR-T toxicities may manifest in different ways emphasizing heterogeneous clinical presentation of CAR-T adverse events, highlighting the need for vigilant monitoring and individualized management strategies. Nonetheless, additional information on the serious adverse effects and long-term effects warrants further investigation.