Algorithm Provides Basis for Patient Safety, Potential Guidelines for Immunotherapy Side Effects

09/19/17

Following a recent literature review, a team of researchers have proposed new guidelines for the systematic management of side effects associated with chimeric antigen receptor T (CAR-T) cell treatment.

The guidelines involve the use of a new algorithm, which can help maintain patient safety as researchers continue to develop and tailor the relatively new CAR-T cell therapies.

"CAR-T cells provide an entirely new level of improved disease response among patients with certain blood cancers and hold promise for more wide-ranging use," said Elizabeth Shpall, MD, University of Texas MD Anderson Cancer Center, in a press release (September 19, 2017).

For their review, Dr Shpall and colleagues assessed data on over 100 patients who had received CAR-T cell therapies at several centers across the United States.

Results of the review indicated that two side effects—cytokine release syndrome (CRS) and CAR-T-cell-related encephalopathy syndrome (CRES)—have become more prevalent with the use of CAR-T cell therapy. These side effects were not common with more conventional blood cancer treatments in the past.

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While the causes of these side effects are currently unknown, researchers have developed a neurological assessment known as the CARTOX-10 algorithm, a simple 10-point test that can quickly identify and treat neurotoxicity in patients receiving CAR-T cell therapies.

"While we all work on those issues, and learn how to better manage and harness these therapies, the CARTOX algorithms provide ground rules for patient safety," Dr Shpall said (September 19, 2017).

The CARTOX algorithms will also be applicable to other cell-based immunotherapies, such as CAR natural killer cells, T cell receptor engineered T cells, and other drugs used in combination with T-cells. —Christina Vogt