Hematologic Oncology Update Toxicities Associated with CAR T-Cell Therapy — An Interview with Dr Matthew Lunning
Dec 4, 2025
Dr. Matthew Lunning, a hematologist-oncologist from the Fred and Pamela Buffett Cancer Center, shares vital insights on managing CAR T-cell therapy toxicities. He discusses the evolution of CRS and ICANS management and highlights the importance of long-term studies and referral timing. Lunning compares CAR T products, emphasizing the advantages of lisocabtagene for older patients. He also shares intriguing case studies that reveal the nuances of treatment outcomes, particularly in managing neurotoxic effects and patient quality of life.
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Early ICU Experiences Shaped Practice
- Dr Matthew Lunning recalls early CAR T experience watching patients in ICU and fearing steroid use might 'kill the CAR.'
- That memory shaped his later approach balancing intervention and preserving CAR T efficacy.
Mechanism Of CRS And Role Of Steroids
- CRS is primarily driven by cytokines (notably IL-6) and tracked by CRP and ferritin changes after tocilizumab.
- Steroids act as a 'brake' to slow CAR T activity and reduce neurotoxicity risk when IL-6 blockers can't cross the blood-brain barrier.
Refer Early And Use Gentle Bridging
- Do refer patients early for CAR T evaluation; start the referral clock at the decision to pursue CAR T.
- Use bridging or 'holding' therapies (e.g., GEMOX, polatuzumab, short radiation) to control disease without compromising eligibility.