CAR T-Cell Therapy

- Welcome to "Micro ED: Quick Facts For Big Issues". My name is Chris Coyne and I'm an emergency physician at UC San Diego. Cancer therapies are advancing at an incredible rate. However, with novel therapies come novel complications. Chimeric antigen receptor T-cell therapy, or CAR T-cell therapy, utilizes the patient's own genetically modified T-cells to fight cancer. While this therapy has been incredibly successful, it also frequently leads to severe complications. While CAR T therapy may seem space aged, these therapies are becoming more common and patients are being discharged earlier from the hospital, which leads to more complications coming into our ERs. These complications come in the form of cytokine release syndrome or CRS and neurotoxicity or ICANS. CRS, which is a spectrum of disease, includes fever, hypotension, and hypoxia. All patients should be treated with maximal supportive care followed by Tocilizumab, which is an IL-6 inhibitor. And in the very, very sick patients, you should treat with steroids. Neurotoxicity, which is also a spectrum of disease, includes headache, confusion, seizures, and sometimes cerebral edema. If highly suspected, these patients should receive steroids. The decision regarding steroids should include the primary oncologist as this therapy will affect therapeutic outcomes. Car T is the future of targeted cancer therapy. It has the potential for amazingly positive outcomes, though can lead to potentially life threatening-complications. Check out our ACEP app which will provide a stepwise instruction on how to treat these CAR T-cell related toxicities.