Clinical development landscape of CAR/TCR-engineered cellular therapies in musculoskeletal sarcomas: a TrialTrove-based registry analysis

Background CAR/TCR-engineered cellular therapies are increasingly investigated in musculoskeletal sarcomas, but the clinical development portfolio spans heterogeneous histologies, platforms, antigens, and basket protocols. We mapped the TrialTrove-derived landscape while explicitly separating engineered-receptor products from other cell-based immunotherapies. Methods TrialTrove clinical trial data were retrieved on 10 June 2026 and constituted the sole data source. Candidate records were identified using prespecified musculoskeletal-sarcoma disease terms and CAR/TCR-engineered-cell product terms. Two investigators independently assessed eligibility and assigned standardized classifications, with disagreements adjudicated by a third investigator. Potential duplicate representations were evaluated using TrialTrove, NCT, and normalized secondary identifiers plus study-level characteristics. We summarized temporal, geographic, phase, status, sponsor, protocol-planned enrollment, platform, target, disease-scope, co-intervention, concentration, and field-availability characteristics. Broader solid-tumor records with explicit sarcoma eligibility were reported separately, the export did not permit consistent determination of actual sarcoma enrollment or a dedicated sarcoma cohort. Results Of 140 identified records, 121 were eligible: 38 (31.4%) were sarcoma-specific and 83 (68.6%) were broader solid-tumour records with explicit sarcoma eligibility. Among 110 records with a start year, 63 (57.3%) began during 2021-2026. Phase I or I/II accounted for 108/121 records (89.3%), and median protocol-planned enrollment was 24 participants (IQR 15-49, n=103). The United States and China contributed 55.2% of 163 trial-country links. TCR-T and CAR-T accounted for 60 (49.6%) and 52 (43.0%) records, respectively. NY-ESO-1 contributed 45/125 trial-target links (36.0%), after excluding 12 Unspecified reporting links, the three most frequent specified antigens contributed 66/113 specified-antigen links (58.4%). Conclusions Engineered cellular-therapy development in musculoskeletal sarcomas has accelerated but remains predominantly early phase, geographically and antigenically concentrated, and represented largely by broader solid-tumour protocols that list sarcoma eligibility. Prespecified sarcoma strata, dedicated and independently analyzable cohorts, biomarker enrichment, harmonized outcomes, and transparent adjunct-strategy reporting should strengthen future evidence generation. This TrialTrove-based record analysis does not establish actual sarcoma enrollment in basket protocols, comparative efficacy, clinical superiority of a platform or antigen, or exhaustive global coverage.