Barry Paul, MD, on Managing CRS and ICANS in Patients Receiving CAR-T for Cancer

This content originally appeared on our sister site, OncLive.

Two adverse events (AEs) associated with chimeric antigen receptor T-cell (CAR-T) therapies are cytokine release syndrome (CRS) and immune effector cell–associated neurotoxicity syndrome (ICANS).

In an interview with OncLive, Barry Paul, MD, assistant professor, the Division of Plasma Cell Disorders, the Department of Hematologic Oncology and Blood Disorders, Atrium Health, discussed the symptoms of these adverse events and how they are typically treated in patients receiving CAR-T for the treatment of cancer.

Paul pointed out that CRS is a systemic inflammatory response which is secondary to the activation of bystander immune and non-immune cells. He explained that the activation of these cells leads to significant increase in interleukin-1 (IL-1) and IL-6, which leads to fever, fatigue, headaches, arthralgias, and myalgias. Paul also noted that more severe cases of CRS can present with hypotension, shock, or multi-system organ failure and mentioned that the syndrome can be managed with tocilizumab (Actemra) if supportive care via antipyretics, acetaminophen, supplemental oxygen, and intravenous fluids is not effective.

Paul also discussed ICANS, highlighting the fact that it occurs when cytokines penetrate the central nervous system (CNS). He explained that ICANs may present with more CNS symptoms, including headache, confusion, and impaired motor skills, and noted that more severe cases may involve aphasia, seizures, cerebral edema, or coma. Paul concluded by mentioning that because tocilizumab is ineffective due to its inability to cross the blood-brain barrier, high-dose corticosteroids are used to treat patients experiencing ICANS.