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New Guidelines Issued on Adverse Effects of CAR T-Cell Therapy

July 25, 2022

August 2022

New guidance from the American Society of Clinical Oncology aims to help clinicians support adult patients in managing immune-related adverse events (AEs) associated with chimeric antigen receptor (CAR) T-cell therapy. Given the lack of high-quality evidence in the literature, the new recommendations are based on expert consensus from a multidisciplinary team. AEs that are discussed include B-cell aplasia, cytokine release syndrome (CRS), immune effector cell-associated neurotoxicity syndrome, and infections. All recommendations are based on benefits outweighing harms. The new recommendations are based on expert consensus from a multidisciplinary team.

“With the increasing use of CAR T-cell therapy in cancer treatment regimens, it is imperative that clinicians are knowledgeable about the symptoms associated with these agents, how best to monitor them, and their recommended management,” according to the panel.

Among the recommendations are supportive care as a first line of care for short-term toxicities in most patients followed by drug interventions for those who don’t respond adequately. For patients with prolonged or severe CRS, tocilizumab alone or with a corticosteroid is recommended. A combination of corticosteroids and supportive care is recommended for patients with moderate to severe immune effector cell-associated neurotoxicity syndrome, given the potential for rapid decline in these patients. Once symptoms improve to grade 1, steroids should be rapidly tapered, the guidelines note.

Source: J Clin Oncol, Nov 1, 2021; Cancer Letter, May 6, 2022.

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