If traditional drugs are 'foreign weapons,' CAR-T cell therapy is like training a patient's own immune cells into an elite force. The medical team first isolates T cells from the patient's blood, equips them in the laboratory with a 'chimeric antigen receptor (CAR)' that can recognize cancer cells, grows them in large numbers, and then infuses them back into the patient. These engineered T cells can multiply in the body, patrol, and continuously hunt down cancer cells carrying the target antigen.
Rewriting the Treatment Curve for Blood Cancers
The most established use of CAR-T is in B-cell blood cancers. CAR-T targeting the CD19 antigen can achieve long-term remission rates of 40 to 50% in relapsed or refractory large B-cell lymphoma—patients who previously had almost no chance of cure. In multiple myeloma, CAR-T targeting BCMA also produces deep and durable remissions. In recent years, research has moved CAR-T to earlier lines of treatment, allowing more patients to receive it when their disease burden is lower, with better efficacy and safety.
Since Taiwan's Act for the Management of Specific Medical Technology and the approval of the first CAR-T product, several medical centers have gained treatment capacity, and the National Health Insurance has recently included specific indications for reimbursement, greatly reducing the financial barrier for patients.
Risks and Care You Need to Know
CAR-T is not without its costs. The most common unique side effects are cytokine release syndrome (CRS) and neurotoxicity (ICANS), which mostly occur within one to two weeks after infusion and require close monitoring at an experienced medical center. In addition, lymphodepleting chemotherapy before treatment, and low blood counts and infection risk after treatment, all require support from a comprehensive care team. With accumulating experience and design improvements in newer-generation products, the incidence of severe side effects has dropped significantly.
Next Steps: Solid Tumors and Off-the-Shelf Products
Currently, the challenge for CAR-T lies in solid tumors—the immunosuppressive tumor microenvironment and the lack of ideal targets are obstacles that need to be overcome. Trials targeting CLDN18.2 (gastric cancer), GPC3 (liver cancer), and other targets are underway. Another direction is 'off-the-shelf' allogeneic CAR-T, which uses cells from healthy donors prepared in advance, eliminating the long wait for customized manufacturing for each patient. For patients with relapsed or refractory blood cancers, multiple next-generation CAR-T trials are recruiting in Taiwan; consult your hematologist-oncologist.