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If CAR-T cell therapies suffer from tumor antigenic escape, why not just resect the tumor via surgery, leaving behind a small number of cancerous cells, and then wipe them out with CAR-T cells? The small number of cancerous cells may reduce the chance of too many cancerous cells escaping CAR-T cell cytotoxic killing that may cause tumor regrowth.

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    $\begingroup$ Can you please make yourself familiar with cancer therapy? Every cancer which can be operated is usually operated to reduce the tumor burden for the patient. And to raise the chances for other therapies to be successful. $\endgroup$ – Chris Sep 8 '16 at 11:01
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    $\begingroup$ To give an appropriate answer is needed to know which type of tumor and the grade of the tumor, because there are specific protocols redacted by medical consensus conferences for each of them. $\endgroup$ – DavideN Sep 8 '16 at 12:44
  • $\begingroup$ I second what @Chris said. As it is now, your question is too undefined to provide a good answer. You're touching on interesting subjects, though. Maybe you can either refine your question to be more specific to a type of tumor, or ask for information on CAR-T therapies more generally? $\endgroup$ – Forest Sep 8 '16 at 14:08
  • $\begingroup$ You've deleted all of your previous questions about CAR T cells, which isn't advisable. However, you don't seem to understand much about cancer therapy in general, and immunotherapy specifically. I would strongly suggest finding several good review articles or reliable websites about the type(s) of cancer you're interested in to get an idea of how cancer therapy works in general (surgical resection, chemotherapy, radiation, immunotherapy, combination therapies, etc.), then move on to understanding immunotherapies in general, then you can begin to apply your recent research on CAR T cells. $\endgroup$ – MattDMo Sep 8 '16 at 14:11
  • $\begingroup$ please read the answer below and follow the links in it, I hope that would resolve this conflict. $\endgroup$ – Arnb Sep 8 '16 at 14:38
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CAR-T cell therapy (Chimeric Antigen Receptor-T cell Therapy) is most effective in treating hematological malignancies. Hematological malignancies (known as blood cancers in common parlance) mean the cancers produced due to over-proliferation of hematopoietic stem cells and the liberation of the immature cells into the circulation . Till now all clinical trials of CAR-T cell therapy has seen more and more success. With the development of second, third and fourth generation (also called TRUCK T cells) CAR-T cells the percentage of remission is increasing. But almost all these advances are in hematological malignancies.

Clinical trials on solid tumors has shown that the "efficacy is not as remarkable as in the case of hematological malignancies".

The question asked was about resection of the tumor before treating with CAR-T cell therapy. This question is valid only in case of solid tumors (you can't resect blood as it is liquid). As I already said this therapy is only used for blood cancer till now, so there is no question of surgery before the therapy.

I think I could answer your query above. If you want to gain more knowledge, then read below -

  1. The best use of this therapy in blood cancers is after hemato-poietic stem cell transplantation (note that it is not surgical resection)
  2. If you ask, why this therapy was not successful in solid tumors, I would recommend to read the review published in Springer with the title "Hurdles of CAR-T cell-based cancer immunotherapy directed against solid tumors".

Recently however there are new developments that are helping to apply this immunotherapeutic procedure in case of solid tumors also and in that case it is usually given after surgical resection.

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