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# CAR T-cell therapies

The patient's own T cells, genetically engineered to recognise a tumour antigen such as CD19 or BCMA and given back as a single infusion.

Updated Nov 1, 2026

## What they are

Chimeric antigen receptor (CAR) T cells are a living drug. T cells are collected by leukapheresis, given a gene for a synthetic receptor, expanded and returned after lymphodepleting chemotherapy. Most approved products target CD19 (B-cell leukaemias and lymphomas); others target BCMA (multiple myeloma). The «-cel» names read «gen» (genetic modification), «leu» (leukocytes) and «cel» (cells).

## Mechanism of action

The CAR joins an antibody fragment (scFv) that recognises the antigen to the T-cell signalling chain CD3ζ and a costimulatory domain (4-1BB or CD28). Binding to the antigen activates the T cell without needing MHC presentation; it kills the target cell, multiplies and can persist. The massive activation releases cytokines such as IL-6.

Target: Tumour surface antigens (CD19 on B cells, BCMA on plasma cells)

## Key points

- Two boxed warnings: cytokine release syndrome (fever, hypotension, hypoxia) and neurological toxicity (ICANS: confusion, aphasia, seizures).
- Tocilizumab (anti-IL-6 receptor), with or without corticosteroids, treats severe cytokine release syndrome.
- Given only at certified centres; the patient stays near the centre for weeks and does not drive for weeks after the infusion.
- Secondary T-cell cancers, including CAR-positive lymphomas, have been reported.
- Loss of the CD19 antigen on the tumour is a common cause of relapse.

## Drugs in this class

- [**Tisagenlecleucel** The first CD19 CAR T-cell therapy: the patient's own T cells, engineered to kill B-cell leukaemia and lymphoma. Main… CD19 on normal and malignant B cells](https://durgical.com/en/pharmacology/tisagenlecleucel/)
- [**Axicabtagene ciloleucel** Anti-CD19 CAR T-cell therapy for large B-cell and follicular lymphoma, given as one infusion. Boxed risks: cytokine… CD19 on normal and malignant B cells](https://durgical.com/en/pharmacology/axicabtagene-ciloleucel/)

## Others in the class

- lisocabtagene maraleucel
- brexucabtagene autoleucel
- idecabtagene vicleucel
- ciltacabtagene autoleucel
- obecabtagene autoleucel

## Test yourself

Think of the answer, then tap the question to see it.

## What are the two main parts of a chimeric antigen receptor?

An antibody fragment (scFv) outside the cell that recognises the antigen and T-cell signalling domains (CD3ζ plus a costimulatory domain) inside.

## Which drug blocks IL-6 signalling in severe cytokine release syndrome?

Tocilizumab, an antibody against the IL-6 receptor.

## Why does a CAR T cell not need MHC to recognise its target?

Because its receptor is antibody-based and binds the surface antigen directly.

## What does ICANS stand for?

Immune effector cell-associated neurotoxicity syndrome.

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Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: [Tisagenlecleucel Injection: MedlinePlus Drug Information](https://medlineplus.gov/druginfo/meds/a617053.html) (MedlinePlus (U.S. National Library of Medicine), 2026); [Axicabtagene Ciloleucel Injection: MedlinePlus Drug Information](https://medlineplus.gov/druginfo/meds/a618003.html) (MedlinePlus (U.S. National Library of Medicine), 2026); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=L01XL) (WHO Collaborating Centre for Drug Statistics Methodology, 2026).

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License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/classes/car-t-cell-therapies/