Lastly, fourth-generation CARs have a transgenic “payload”, also known as T-cells Redirected towards Universal Cytokine Killing (TRUCKs), which include additional anti-tumor activity such as inducible cytokine production, such as IL-12, IL-15, IL-18, and IL-23 or stimulatory ligands to influence the local tumor microenvironment (TME) and reduce systemic toxicity[15-20]. This evidence concerns the gene IL18 and neoplasm.