Optimization of CAR T-cell dose: a debated unresolved issue



Summary

Optimizing the dose of CAR T-cells remains a contentious issue in immunotherapy. While higher doses theoretically offer enhanced tumor eradication, they also increase the risk of severe toxicities like cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). Conversely, lower doses may be safer but might lead to treatment failure due to insufficient T-cell expansion or persistence. Clinicians are actively exploring factors influencing dose response, including tumor burden, CAR T-cell phenotype, and patient characteristics. Finding the “sweet spot” – a dose that maximizes efficacy while minimizing toxicity – requires ongoing clinical trials and refined strategies for patient stratification and toxicity management. The optimal CAR T-cell dose remains a crucial unresolved challenge in the field.

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