Durable Molecular Remissions in Chronic Lymphocytic Leukemia Treated With CD19-Specific Chimeric Antigen Receptor-Modified T Cells After Failure of Ibrutinib

Trial watch: Immunogenic cell death induction by anticancer chemotherapeutics

The expression "immunogenic cell death" (ICD) refers to a functionally unique form of cell death that facilitates (instead of suppressing) a T cell-dependent immune response specific for dead cell-derived antigens. ICD critically relies on the activation of adaptive responses in dying cells, culminating with the exposure or secretion of immunostimulatory molecules commonly referred to as "damage-associated molecular patterns". Only a few agents can elicit bona fide ICD, including some clinically established chemotherapeutics such as doxorubicin, epirubicin, idarubicin, mitoxantrone, bleomycin, bortezomib, cyclophosphamide and oxaliplatin. In this Trial Watch, we discuss recent progress on the development of ICD-inducing chemotherapeutic regimens, focusing on studies that evaluate clinical efficacy in conjunction with immunological biomarkers.

Cancer Immunotherapy with Chimeric Antigen Receptor (CAR) T Cells

Chimeric antigen receptor T cell (CAR T) therapy recently won its first U.S. Food and Drug Administration approval for use in the treatment of patients aged 3-25 with relapsed or refractory acute lymphoblastic leukemia. CAR T cell therapy is the first approved gene therapy in the USA, and brings with it a new paradigm in cancer therapeutics. Advances in design and manufacturing of CAR T cells have led to dramatic improvements in outcomes for patients with B cell malignancies. As clinical trial experience with CAR T cells grows, adverse events associated with CAR T cell therapy are becoming better understood. Increasing amounts of data suggest that CAR T cell therapy can lead to both dramatic clinical responses and to life-threatening cytokine release syndrome. As more patients are treated with CAR T cells, specialists from a multitude of fields will be involved in monitoring for and/or managing toxicity. Major obstacles in the field include expanding the promise of CAR T cells into other more challenging tumor types, such as myeloid malignancies and solid tumors. In addition to uses in oncology, this review will look to other potential applications of this technology to nonmalignant disease.