Dados do Resumo

Título

Impact of immunomodulatory therapies in oncology: An integrative review of CAR-T and TIL treatments

Introdução

Immunotherapy has led to a paradigm shift in cancer treatment. In this perspective, it is mostly based on therapeutic antibodies targeting a wide range of proteins/receptors, such as PD-1/PD-L1 and Toll-like Receptors (TLR). In this context, due to limitations in pharmacokinetics, including long half-lives, poor tumor penetration, and low oral bioavailability, the widespread use of these therapies is constrained, impacting the intrinsic potential for better patient prognosis.

Objetivo

Evaluate and compare the effects of immunomodulatory therapies, particularly in the treatment of advanced cancers, highlighting objective response rates, adverse effects, and impact on survival in patients with unfavorable prognoses.

Métodos

This study is an integrative review conducted in the PUBMED database, with descriptors including 'Effect of immunomodulators' and 'Cancer treatment,' and Boolean operators 'AND' and 'NOT' were used. Inclusion criteria were articles from 2019 to 2024, case reports, meta-analyses, and randomized controlled trials. Exclusion criteria were articles that did not meet the inclusion criteria, did not assess the effect of immunomodulators, and systematic review articles.

Resultados

The results show that the effects of immunomodulators vary between patients with gastrointestinal cancers and advanced melanoma. In the gastrointestinal tumor group, 30 patients were treated with CAR-T cells specific for Claudin 18.2, achieving an objective response rate of 43% (5 complete responses and 8 partial responses). The most common adverse effects were cytokine release syndrome (63%) and neurotoxicity (37%). In the advanced melanoma group, 156 of 189 candidates received TIL infusion with lifileucel, resulting in an objective response rate of 31.4% (8 complete responses and 40 partial responses). Serious adverse events included thrombocytopenia (76.9%), anemia (50.0%), and febrile neutropenia (41.7%). The median survival was 6 months for CAR-T and 13.9 months for lifileucel. Compared to other oncology therapies, both showed promising potential to improve survival in patients with unfavorable prognoses.

Conclusões

The integrative review highlights that CAR-T cell therapy for gastrointestinal tumors and tumor-infiltrating lymphocyte (TIL) therapy for advanced melanoma offer promising potential to improve survival in patients with unfavorable prognoses, standing out compared to other oncology approaches. However, the significant rate of adverse events underscores the need for careful monitoring and further studies to better assess the safety of these immunomodulators.

Palavras Chave

Immunomodulators; Câncer; treatment