Chimeric antigen receptor (CAR) T cell therapy: current landscape, challenges, and future horizons in hematologic and solid tumors

Chimeric antigen receptor (CAR) T cell therapy has emerged as a transformative modality in cancer immunotherapy, particularly for hematologic malignancies. By genetically engineering patient-derived T cells to express synthetic receptors targeting tumor-associated antigens, CAR T cells enable precise tumor recognition and potent cytolytic activity independent of major histocompatibility complex (MHC) presentation. To date, six FDA-approved CAR-T therapies have demonstrated remarkable clinical efficacy in relapsed or refractory leukemia, lymphoma, and multiple myeloma, with durable remissions reported in otherwise treatment-resistant cases. This review provides a comprehensive overview of CAR-T therapy development, molecular design, and mechanisms of action. It further explores clinical applications in both hematologic and solid tumors, highlighting therapeutic advances in breast, lung, and pancreatic cancers. Additionally, we discuss key toxicities, including cytokine release syndrome and neurotoxicity, and examine strategies for improving safety and efficacy. Finally, we outline future directions for CAR-T engineering and potential non-oncologic applications, underscoring the vast horizon of this personalized immunotherapy.