iwAL 2025 | Strategies for CRS prophylaxis in patients treated with CAR-T: beyond tocilizumab and anakinra

So I’m not sure if prophylaxis with tocilizumab is wise, and I’m not sure if anakinra works. So the answer to your question is, for those particular drugs, I’m not sure that either have a real important place as prophylaxis or upfront therapy. Now, they certainly have a, certainly tocilizumab has a role for the treatment of cytokine release syndrome (CRS). I’m not as convinced for anakinra. But the main thing for prophylaxis is it has to be easy, and it can affect count recovery. It can affect other toxicities. It can affect relapse. And so one, I’m very sort of enamored by the possibility of giving an antibody to block some of these signaling pathways. Early on, the antibody lasts for a while and actually lasts for one to two weeks during the high-risk period of CRS. And you also give it once, and the patient can actually be treated as an outpatient. This will save enormous amounts of angst and money in centers that are always worried about reimbursement for patients who have to be readmitted for CRS. So I think prophylaxis, in theory, is a really important advance in the treatment of patients getting CAR T-cell therapies. And keeping people out of the hospital, the cost of treatment will go way down. And also, this risk of reimbursement issues will go away. And so I don’t think that anakinra or tocilizumab, per se, are the answers. But there may be other antibodies, gamma interferon antibodies, antibodies to CD40 ligand, something else that actually can be given once and takes care of it. The other option is a pill. You take a pill like a JAK inhibitor or something like that for a week or two, that may be another alternative. Those are going to have other side effects and other problems with count recovery.

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