NCCN Patient Guidelines Highlight Side Effects of Immunotherapy, CAR T-Cell Therapy

July 3, 2020

Immunotherapy and chimeric antigen receptor (CAR) T-cell therapy are new and important treatments revolutionizing care of some cancers; however, their side effects can be very different than what is seen in traditional approaches, such as chemotherapy.

While immunotherapy has become an important treatment option for some cancers, and it is often well tolerated, it can have different side effects than traditional approaches, such as chemotherapy. The National Comprehensive Cancer Network (NCCN) recently released a new set of guidelines to help patients and caregivers understand the unique and severe side effects of immune checkpoint inhibitors (ICIs), a common type of immunotherapy.

The patient guidelines provide the information of the evidence-based, expert-consensus clinical practice guidelines used by health care providers in an easy-to-understand way so patients and caregivers can better understand treatment options.

“Immune checkpoint inhibitors have revolutionized our approach to the treatment of cancer,” John A. Thompson, MD, professor of medicine at the University of Washington and chair of the NCCN Clinical Practice Guidelines in Oncology Panel for Management of Immunotherapy-Related Toxicities, said in a statement. “ICIs are now approved by the FDA for treating more than a dozen forms of cancer and the list is growing every year. However, by virtue of stimulating the patient’s immune white blood cells, ICI therapy sometimes causes serious side-effects that mimic autoimmune disease, including significant rash and/or inflammation of the thyroid, liver, lungs, nervous system, glandular system, heart, or other organs.”

The guideline explains that immune-related adverse events can start during or after immunotherapy, but most can be managed if identified and treated early.

NCCN also released patient guidelines on the side effects of chimeric antigen receptor (CAR) T-cell therapy. Olalekan Oluwole, MD, of Vanderbilt-Ingram Cancer Center and a member of the NCCN Guidelines Panel for Management of Immunotherapy-Related Toxicities, explained that traditional chemotherapy attacks all cells and can leave patients with long-term complications, such as other forms of cancer, but CAR T-cell therapy attack cancer cells in a different and more targeted way.

“The targeting is akin to a heat seeking missile that won't stop until it takes out any cell with the target, leading to potential long-term or permanent remission,” Oluwole said in a statement. “CAR T is given one time, unlike chemotherapy, which is given over multiple cycles and could go on for months or years. However, 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.”

Patients are being monitored for cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). In CRS, immune cells affected by the treatment release cytokines into the blood, which creates an intense systemic inflammatory response. In ICANS, there are a range of neurological side effects. However, both CRS and ICANS can be reversed if they are treated promptly, which is why patients are monitored closely following treatment.

“CRS can set in rapidly, pushing the patient’s body to very high temperatures and taking quite a toll,” said Oluwole. “However, we researchers are learning more about how to collaborate to predict toxicities and sharing knowledge on recognizing and treating them more quickly. The new NCCN Guidelines for Patients are yet another example of how we’re sharing this important information.”