Dr. Galal on Managing AEs Linked With CAR T-Cell Therapy

Ahmed Galal, MD, instructor, Department of Medicine, Duke Cancer Institute, discusses the management of adverse events (AEs) associated with CAR T-cell therapy.

When CAR T-cell therapy was first introduced to the field of non-Hodgkin lymphoma, there was a lot of concern over potential AEs and how to treat them, says Galal. Steroids were the predominant method of treatment since they could affect the CAR T cells by decreasing their activity. Steroids continue to be used to treat patients who develop AEs that manifest as a result of this approach.

Now, steroids are being used even earlier on to treat these patients when they show early signs of cytokine release syndrome (CRS). Even so, most AEs are discovered at the grade II level. The hope is that increased awareness will shift the field toward less grade 3/4 neurotoxicity, says Galal. Additionally, a lot of research is devoted to enhancing the product itself, and in doing so, decrease CRS and neurotoxicity. Currently, researchers are working on developing “on and off switch” for CAR T-cell therapy.