A Comprehensive Review on Car- T Cell Therapy in Cancer Management

CAR-T (Chimeric Antigen Receptor T-cell) therapy has emerged as a transformative approach in cancer management, particularly for hematological malignancies such as acute lymphoblastic leukemia, diffuse large B-cell lymphoma, and multiple myeloma. By genetically modifying a patient’s T cells to express CARs, these therapies enable precise recognition and destruction of tumor cells while bypassing conventional immune checkpoints. First and second generation CARs laid the foundation for clinical success, while next-generation designs—including armored and fifth-generation CARs, dual-target CARs, and off-the-shelf allogeneic products—aim to improve efficacy, persistence, and safety, and expand applicability to solid tumors. Despite impressive outcomes, challenges remain. Adverse events such as cytokine release syndrome (CRS) and immune effector cell–associated neurotoxicity syndrome (ICANS) necessitate careful monitoring and specialized management. Resistance and relapse can occur due to antigen loss, limited CAR-T persistence, or immunosuppressive tumor microenvironments, particularly in solid tumors where trafficking and infiltration remain obstacles. Advances in CAR engineering, combination therapies, and optimized manufacturing are actively addressing these limitations. Overall, CAR-T therapy exemplifies the potential of precision immunotherapy, offering durable remission for select patients while highlighting the need for continued innovation to enhance safety, overcome resistance, and broaden its clinical impact across hematological and solid malignancies.