ASH 2024 | Strategies to mitigate ICANS as a side effect of CAR T-cell therapy
Christopher D’Angelo, MD, University of Nebraska Medical Center, Omaha, NE, discusses strategies to mitigate immune effector cell-associated neurotoxicity syndrome (ICANS) as a side effect of CAR T-cell therapy. He suggests de-bulking patients and exploring new immune-modulatory therapies, such as anakinra, to reduce ICANS toxicity and its long-term consequences. This interview took place at the 66th ASH Annual Meeting and Exposition, held in San Diego, CA.
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Transcript
I think the best thing that we can do and when we’re thinking about managing, in particular, neurologic toxicities and ICANS toxicity, is trying to de-bulk patients as much as possible. Sometimes that can be a difficult task. Early recognition and probably earlier use of more effective therapy. Steroids can help, but other immune-modulatory therapies like anakinra, for example, earlier use of it and at a higher dose can potentially lead to earlier resolution of ICANS and certainly exploring new constructs that are able to have demonstrated lower rates of ICANS to begin with...
I think the best thing that we can do and when we’re thinking about managing, in particular, neurologic toxicities and ICANS toxicity, is trying to de-bulk patients as much as possible. Sometimes that can be a difficult task. Early recognition and probably earlier use of more effective therapy. Steroids can help, but other immune-modulatory therapies like anakinra, for example, earlier use of it and at a higher dose can potentially lead to earlier resolution of ICANS and certainly exploring new constructs that are able to have demonstrated lower rates of ICANS to begin with. More research will need to be done to truly understand if this will protect people long term and to just definitively prove that there is an ongoing risk of neurologic toxicity in patients that endure any degree of ICANS toxicity, but certainly drawing some attention to the fact that we need to be more mindful of this, not just in the short-term period, but because it might also have long-term ramifications for our patients as well. We want them to be cured of their disease, but not lingering with any ongoing chronic toxicities either.
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Disclosures
Abbvie: Consultancy; Bristol Myers Squibb: Consultancy, Research Funding; Genmab: Consultancy; Fate Therapeutics: Research Funding; Seagen: Consultancy; Beigene: Research Funding; Curis Inc: Consultancy, Research Funding.
