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Immuno-oncology has been at the forefront of cancer treatment in recent decades. In particular immune checkpoint and chimeric antigen receptor (CAR)-T cell therapy have achieved spectacular results. Over the years, CAR-T cell development has followed a steady evolutionary path, focusing on increasing T cell potency and sustainability, which has given rise to different CAR generations. However, there was less focus on the mode of interaction between the CAR-T cell and the cancer cell; more specifically on the targeting moiety used in the CAR and its specific properties. Recently, the importance of optimizing this domain has been recognized and the possibilities have been exploited. Over the last 10 years—in addition to the classical scFv-based CARs—single domain CARs, natural receptor-ligand CARs, universal CARs and CARs targeting more than one antigen have emerged. In addition, the specific parameters of the targeting domain and their influence on T cell activation are being examined. In this review, we concisely present the history of CAR-T cell therapy, and then expand on various developments in the CAR ectodomain. We discuss different formats, each with their own advantages and disadvantages, as well as the developments in affinity tuning, avidity effects, epitope location, and influence of the extracellular spacer.

Original languageEnglish
Pages (from-to)306-342
Number of pages37
JournalMedicinal Research Reviews
Issue number1
Publication statusPublished - Jan 2022

Bibliographical note

Funding Information:
Research support was provided by the Research Foundation Flanders (Fonds Wetenschappelijk Onderzoek [FWO]) through research project G028220N and personal mandates to Kim De Veirman (12I0917N), Heleen Hanssens (1S55619N) and Fien Meeus (1S68521N). All figures were created with BioRender.com .

Publisher Copyright:
© 2021 The Authors. Medicinal Research Reviews published by Wiley Periodicals LLC

Copyright 2022 Elsevier B.V., All rights reserved.


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