Dr. Lekakis on Managing the Toxicity of CAR T-Cell Therapy

Lazaros John Lekakis, MD, associate professor of clinical medicine, Sylvester Comprehensive Cancer Center, University of Miami, discusses ways of managing the toxicity of CAR T-cell therapy.

One of the biggest challenges with CAR T-cell therapy is the toxicity profile, as there are a number of unanswered questions, Lekakis says. For grade 3/4 neurotoxicity, high-dose steroids are typically given. Steroids may also be appropriate for patients with grade 2 neurotoxicity, says Lekakis. However, researchers don’t yet know the impact of corticosteroids on T cells.

One toxicity that researchers struggle with is a rare condition called cerebral edema, Lekakis notes. This is the most severe case of neurotoxicity a patient can develop. Cerebral edema occurs in 1% to 2% of patients treated with CAR T-cell therapy, but it is mostly fatal. Physicians currently manage this with corticosteroids in an attempt to induce hypocapnia, but it remains a major challenge.