Reacción a "A patient has been in remission from cancer for 18 years after CAR-T treatment as a child, the longest period ever described"

This is a well-documented and good quality case study 18 years after being treated with anti-GD2 CAR-T cells. The case is proof that first-generation CARs can endure and function if the CAR-transduced T-cell has this option and without the need for co-stimulatory domains. In this case, the splitting of anti-Epstein Barr virus (EBV) T lymphocytes allows the TcR receptor to enable this survival and function for a solid tumor. 

It fits with existing evidence, but underscores the importance of endogenous TcR (the importance of the patient's lymphocytes over - or alongside - the CAR-T molecule itself). 

The main implication is to recapture the concept that the use of antigen-specific T lymphocytes can 'enhance' the CAR-T approach. The Baylor group had already demonstrated the 'goodness' of using VST [virus-specific T lymphocytes] in combination with CAR molecules, but here we show the highest survival case so far with a CAR-T that in addition to being first generation is against a solid tumor antigen. 

The main limitation is that it is only one case of such long survival (there are others, but not as long) and that, given the success of this case, first-generation proposals are resumed. The data on the role of the anti-EBV TcR(s) do not indicate in a scientifically clear way the physiopathogenesis of this combination of receptors, the natural one (TcR) and the chimeric one (CAR).