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Transcript
Katherine Banwell:
What are the most common early side effects, and what do they actually feel like for patients?
Beth Faiman:
Yes. The most common side effects I described briefly early on. Number one, the CRS or cytokine release syndrome. That occurs when our programmed cells are reinfused into the body. And about day seven after that reinfusion is when patients are at the highest risk for a high fever.
And that’s a sign that these cells are doing their job. The CARs are expanding in one’s bloodstream, and they’re being programmed to be fighters, to circle around in the bloodstream like a living drug.
So, that high fever can occur, but we have a drug called tocilizumab (Actemra) which we administer to turn off that process. It’s what’s called an anti-IL6 drug, and it blocks that chemical that triggers that immune response.
It doesn’t negatively affect the CAR T cells or limit your ability to react to it. The second thing is the neurotoxicity. It can start as a little bit of a headache.
The nurses and doctors if you’re in the hospital or as an outpatient will ask you regularly, “Count back from 100 by 10. Where are you at? What’s your name?” and ask you to do a handwriting sample among other things.
And so, that will let us know if you’re having any signs of this neurotoxicity. If so, we give you steroids called dexamethasone (Decadron) to turn that process off. And then finally, things that should be monitored as well would be for infection. Signs of infection as you can imagine would be a high fever and chills which look like that CRS as well. So, in parallel, we’re going to make sure that the individual doesn’t have an infection, and we’re going to make sure that the patient’s CRS is what we think it is if the time is right as addressed.
And so, if you have an outpatient CAR T with a strong support, somebody that’s there 24 hours a day, seven days a week to support that patient, you can get an outpatient CAR T successfully delivered. But we want those individuals to be our eyes and ears for the healthcare providers and report promptly. And more communication, and I already talked about how important communication is, but we can’t intervene on a problem if we don’t know that one is having one.
Katherine Banwell:
Exactly. Yeah. So, you’re saying there are definitely some symptoms that should not be ignored. How can early reporting of side effects improve outcomes?
Beth Faiman:
Yes. So, a little bit of a fever, maybe 100.4, some patients will say, “I’m just going to go back to sleep. I’ll be fine.” But if we know you have that fever or we instruct you to take two Tylenol and maybe some dexamethasone if we think it’s this cytokine release syndrome starting, if we know how to intervene and intervene quickly and have that open line of communication, it can prevent it from getting more severe.
There are more severe signs of that CRS. Most people have mild these days especially with better disease control, giving these therapies earlier on, and better supportive care. But if we don’t treat that CRS, then it can lead to low blood pressure or hypotension. And you can require oxygen in severe stages.
So, again, let your healthcare team know if you’re having any side effects of treatment. I do want to address something that we’ve been more aware of lately in the myeloma community is that there is this late side effect that mimics Parkinsonism. And it happens after day 30. And it might start as a mild tremor.
And people will say, “Oh, it’s nothing. I’m just more tired.” But we need to know if you’re having any of these rare side effects because, again, we can give you medications and hopefully intervene before they become worse.
So, talking to your healthcare team, finding a team that you feel comfortable and confident with I think is a recipe for success when you’re considering CAR T-cell therapy.