Terapia com células CAR-T em gliomas: eficácia, desafios e perspectivas futuras

Abstract

The present study investigated CAR-T cell therapy in gliomas, the most common primary brain neoplasms in adults. This therapy involves the collection of T cells from the peripheral blood of patients or donors, followed by genetic modification in vitro to express the chimeric antigen receptor (CAR). The binding of the CAR to target antigens expressed on the cell surface results in vigorous T cell activation and powerful antitumor responses, as the activated cells specifically identify targets on neoplastic cells, leading to their destruction. CAR-T cell immunotherapy holds enormous potential for the treatment of high-grade gliomas. This study aimed to elucidate the current perspectives on CAR-T cell immunotherapy in gliomas. The methodology adopted involved a systematic literature review guided by the PRISMA method (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) in the following databases: PubMed and CAPES Journals. The descriptors used were: “glioma,” “immunotherapy,” “genetics,” and “therapy.” These descriptors were combined using the Boolean operators “AND” and “OR” as follows: “Glioma AND (Immunotherapy AND CAR-T cells).” Inclusion criteria were articles published in any language between 2014 and 2024, whose titles included at least one of the selected descriptors and had the full text available. Exclusion criteria included methodologically weak or inconsistent studies that were not primary research. A total of 31 studies were obtained. The extracted data involved the analysis of the current stage of CAR-T cell research, factors influencing survival and recurrence, as well as adverse effects and treatment feasibility. The study highlighted that gliomas are intra-axial brain tumors with a high recurrence rate and a tendency to spread diffusely throughout brain tissue. This dissemination complicates treatment, and surgical removal of the tumor is extremely challenging, often making complete resection of the tumor mass impossible. The introduction of new therapies, such as the use of CAR-T cells, is highly relevant, given their greater specificity and potential for personalized treatment, representing a promising alternative to overcome the limitations of conventional therapies. However, further studies are needed to ensure greater safety for patients, as well as increased specificity and efficacy.