What are the common side effects of CAR T-cell therapy and how are they managed?

What are the common side effects of CAR T-cell therapy and how are they managed?

You know, if we could give CAR T-cells to all relapsed refractory patients with large cell lymphoma across this country, it would be fantastic. But there are a lot of issues getting patients to CAR-T, so not all the needy patients get it. Access is one of the biggest issues with this form of as you said, magical, newer, very expensive, complex therapy. So there are insurance challenges, logistical challenges, and geographic issues that sometimes don't make the needy patients actually get it.

And so that kind of limits nationally in many studies now, we think only 20 to 30% of all the patients who actually need CAR-T ended up getting it. So that's a big discrepancy in who actually finally gets the CAR T-cells. And a lot of work needs to be done at multiple levels. Patient physician system levels to kind of make that happen.

The other question is like, what are the things that patients are worried about with CAR-T are obviously, this is a newer treatment that we've been now doing on a commercial basis over the last 7 to 8 years for large cell lymphoma since first approval. But there are some unique side effects with this treatment.

So as I said, especially with some of the CAR-T products, it's delivered in the hospital. So hospitalization component is needed. And why we do that is to monitor for certain unique side effects. So one of the side effects that is well talked about now, and it's no longer like a, you know, a distant thing or a complex thing. It's something called a cytokine release syndrome or CRS.

So this is the initial manifestation that happens when the T-cells go inside the patient's body at multiplying, seeking out the cancer, destroying it, releasing a bunch of chemicals into the bloodstream. Patients can have high fever. They could drop their oxygen. They may need drop their blood pressure. And this needs a lot of critical care monitoring in the hospital. And only equipped centers can do that. And we act on that with remedial measures, including an antibody called tocilizumab, which is used, immediately to calm the storm.

So CRS could be life threatening. And that's something we educate patients on several occasions before they go into the hospital. The second most unique are the toxicity with these CAR-T cells is something called as neurologic toxicity, where after a period of maybe 5 or 7 days after the cells, patients may start having some confusion. They may have difficulty remembering things. They may have difficulty with handwriting and memory issues.

So one of the questions that comes up when we discuss this is, am I going to get demented? Am I going to have memory issues of brain fog for the rest of my life? The answer is in more than 95 to 100%, almost close to hundred percent of patients. That does not happen. This memory issue is also something that we call as ICANS. It's a long name for the neurologic toxicity that happens after CAR-T cells. But most of the time it's transient and short lived.