Journal article
CAR-T and checkpoint inhibitors: toxicities and antidotes in the emergency department
Clinical toxicology (Philadelphia, Pa.), Vol.59(5), pp.376-385
05/04/2021
DOI: 10.1080/15563650.2021.1880008
PMID: 33576256
Abstract
Introduction
New cancer treatments with immunotherapy have led to unique toxicities affecting cancer patients. As cancer-related visits to the emergency department increase, the emergency physician and the medical toxicologist should be aware of immunotherapy-related toxicities. In this review we discuss immune related adverse events (irAEs) from chimeric antigen receptor T (CAR-T) cell therapy and immune checkpoint inhibitors (ICI).
Discussion
While presentation of the irAEs may mimic common conditions, it is important to recognize them as they may be life-threatening. A thorough history and examination of the patient, including their cancer treatment history in the past year is crucial. Conditions such as cytokine release syndrome (CRS) and immune effector cell associated neurotoxicity syndrome (ICANS), which can occur after CAR-T treatment, can progress rapidly to a fatal outcome if not recognized and managed in a timely manner. ICI can affect any organ system and irAEs may present like a typical autoimmune disease of the affected organ. While most of the irAEs we discuss in this review will benefit from treatment with glucocorticoids, it is important to know the grade of the condition, as it will determine the treatment dose, route and further management considerations.
Conclusion
Patients experiencing irAEs from ICI and CAR-T can present with subtle symptoms that can rapidly progress if not recognized early. The emergency physician and the medical toxicologist should keep in mind these toxicities and the patient's oncologic history to adequately recognize and manage these conditions.
Details
- Title: Subtitle
- CAR-T and checkpoint inhibitors: toxicities and antidotes in the emergency department
- Creators
- Demis N. Lipe - The University of Texas MD Anderson Cancer CenterSarah Shafer - University of Iowa, Emergency Medicine
- Resource Type
- Journal article
- Publication Details
- Clinical toxicology (Philadelphia, Pa.), Vol.59(5), pp.376-385
- Publisher
- Taylor & Francis
- DOI
- 10.1080/15563650.2021.1880008
- PMID
- 33576256
- ISSN
- 1556-3650
- eISSN
- 1556-9519
- Number of pages
- 10
- Grant note
- CA016672 / National Institutes of Health through MD Anderson's Cancer Center Support Grant; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA
- Language
- English
- Date published
- 05/04/2021
- Academic Unit
- Emergency Medicine
- Record Identifier
- 9984695941102771
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