Chimeric antigen receptor (CAR)-T-cell therapy has revolutionised haematological cancer treatment. However, its application in solid tumours remains significantly limited by the immunosuppressive tumour microenvironment (TME), poor antigen specificity, and physical barriers to infiltration. This review explores a compelling question: can CAR-T cells be adapted to overcome immunosuppression in solid tumours effectively? We provide an in-depth analysis of the immunological, metabolic, and structural challenges posed by the TME and critically evaluate emerging engineering strategies designed to enhance CAR-T cells’ persistence, targeting, and function. These include metabolic reprogramming, hypoxia-responsive constructs, checkpoint-resistant designs, and innovative delivery techniques such as locoregional administration and nanotechnology-assisted targeting. We highlight promising preclinical and early clinical studies demonstrating that armoured CAR-T cells secreting cytokines like interleukin (IL)-12 and IL-18 can reprogram the TME, restoring antitumour immunity. Moreover, we examine synergistic combination therapies that integrate CAR-T cells with immune checkpoint inhibitors, radiotherapy, oncolytic viruses, and epigenetic modulators. Special attention is given to personalised strategies, such as bispecific targeting and precision delivery to tumour-associated vasculature or stromal elements, which are showing encouraging results in overcoming resistance mechanisms. This review aims not only to synthesise current advancements but also to ignite optimism in the potential of CAR-T-cell therapy to breach the immunological fortress of solid tumours. As we enter a new era of synthetic immunology, this evolving landscape offers hope for durable remissions and novel treatment paradigms. For clinicians, researchers, and biotech innovators, this paper provides a roadmap toward transforming a therapeutic dream into clinical reality.

Introduction: Liver resection remains one of the fundamental treatment modalities for both malignant and benign hepatic diseases; however, it is still associated with a significant risk of intraoperative bleeding. Reducing blood loss and the need for transfusion is crucial for perioperative outcomes and long-term prognosis. The Coolingbis system, which utilizes a cooled monopolar radiofrequency electrode, represents a novel method of achieving hemostasis during hepatic parenchymal transection. Aim: The aim of this study was to evaluate the impact of the Coolingbis system on intraoperative blood loss, the need for blood product transfusions, and the perioperative course in patients undergoing liver resection. Materials and Methods: A retrospective analysis was conducted on 58 patients who underwent surgery for liver lesions between 2022 and 2024. The Coolingbis system was used in 25 patients, while conventional hemostatic techniques were applied in 33 patients. Intraoperative blood loss, operative time, transfusion rate, length of hospital stay, postoperative complications, and mortality were analyzed. Statistical analysis was performed using the Kruskal–Wallis test, the chi-square test, and Fisher’s exact test. Results: Intraoperative blood loss was significantly lower in the Coolingbis group compared with the conventional techniques group (338.0 450.1 mL vs 607.6 752.5 mL; p = 0.0062). Blood product transfusions were less frequent in the Coolingbis group (12.0% vs 24.2%; p = 0.0410). No significant differences were observed between the groups in terms of operative time or length of hospital stay. The rate of postoperative complications was lower in the Coolingbis group; however, the difference did not reach statistical significance. Age, sex, and BMI had no significant impact on intraoperative blood loss. Conclusions: The use of the Coolingbis system in liver resections is associated with a significant reduction in intraoperative blood loss and transfusion requirements, without an increased risk of complications. This technique may represent a valuable adjunct to conventional hemostatic methods in liver surgery.

Introduction and Importance: Colorectal adenocarcinoma typically metastasizes to the liver and lungs, with pleural, breast, or osseous involvement being exceedingly rare. Here, we report an unusual case of rectal adenocarcinoma metastasizing to the chest wall with simultaneous involvement of the lung, pleura, ribs, and subcutaneous breast tissue, forming a dominant giant metastasis (25 × 18 × 16 cm) accompanied by additional satellite lesions between the ribs and pectoral muscles, as well as intrapulmonary nodules. Presentation of case: The patient underwent radical resection including rib excision, followed by hyperthermic intrathoracic chemotherapy (HITHOC) with mitomycin. Chest wall integrity was restored using a synthetic mesh and titanium plating, ensuring both oncologic clearance and structural stability. Multimodal therapy also included neoadjuvant chemotherapy with bevacizumab, which was continued postoperatively. Clinical discussion: This case underscores the critical role of a multidisciplinary strategy in managing rare and aggressive metastatic patterns of colorectal cancer. In selected patients, a combination of systemic therapy, extensive surgical resection, advanced reconstruction, and regional chemotherapy may offer the potential for short-term local disease control. Conclusions: The radical excision of the giant tumour enabled continuation of systemic therapy under the national drug programme, was associated with short-term local control, and improved the patient’s quality of life.

Cancer precision medicine is moving beyond static, single-analyte profiling toward a dynamic view of tumour biology and treatment response. A multiomics approach, integrating genomic, transcriptomic, proteomic, metabolomic, and epigenomic information, offers a more comprehensive framework for understanding tumour heterogeneity and therapeutic vulnerability. This review examines the emerging landscape of clinically available, translational, and experimental approaches, spanning commercially available platforms such as CureResponse and Exacta, single-cell and spatial technologies, AI-assisted plasma multiomics, and functional platforms including BH3 profiling and patient-derived organoid drug screening. We also discuss longitudinal liquid biopsy approaches for minimal residual disease assessment and recurrence monitoring. Together, these technologies may extend conventional biopsy by enabling increasingly multidimensional, spatially resolved, and longitudinal assessment of cancer. However, their clinical implementation remains limited by challenges in analytical standardisation, data integration, biological interpretation, validation, and demonstrated clinical utility. The convergence of multiomics, single-cell and spatial profiling, artificial intelligence, and functional testing is therefore reshaping precision oncology, from describing what a tumour is to predicting how it may behave and respond to treatment.