Guide for Patients Describes Possible Side Effects of CAR T-Cell Therapy

July 4, 2020

The patient guide explains 2 possible side effects, cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome, that need to be caught quickly in order to be reversible.

Patients who receive chimeric antigen receptor (CAR) T-cell therapy are benefiting from a key advance in cancer care, albeit one that also comes with the risk of cytokine release syndrome (CRS) and other unique side effects. A new patient guide from the National Comprehensive Cancer Network (NCCN) explains the possible side effects of CAR T, including neurological ones.

In CRS, T cells that have been activated release cytokines that activate other immune cells; this in turn releases more cytokines into the bloodstream. Consequently, the patient can experience high fever, severe flu-like symptoms, and other complications; CRS typically requires a stay in the intensive care unit.

“Patients are often surprised to learn that the single CAR T infusion includes a 28-day monitoring period during which they need to stay in close proximity to their treatment center,” said Olalekan Oluwole, MD, Vanderbilt-Ingram Cancer Center, and a member of the NCCN Guidelines Panel for Management of Immunotherapy-Related Toxicities.

Besides CRS, the medical team is also watching for immune effector cell-associated neurotoxicity syndrome (ICANS)—a range of neurological side effects. Those may include delirium, nerve dysfunction, aphasia, seizures, and brain swelling.

Both CRS and ICANS are generally reversible if treated promptly.

CAR T therapy starts at $373,000 for a 1-time treatment, but severe complications can easily push the total cost of care to $1 million. It is hoped that the next generation of CAR T-cell therapies will have fewer side effects.

The publication of the CAR T guide completes a series for patients about immunotherapy side effects, NCCN said.