The Intern At Work: Internal Medicine 263. Cytokines Everywhere All at Once: Approach to CRS and ICANS
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Dec 15, 2024 Veronica Ramirez, an Internal Medicine Resident, dives deep into the implications of CAR-T therapy in treating cancer. She discusses the rising prevalence of Cytokine Release Syndrome (CRS) and Immune Effector Cell-Associated Neurotoxicity Syndrome (ICANS) in medical wards. Listeners will learn about essential treatment protocols and the importance of early diagnosis. With recent advancements in managing these conditions, this conversation is a must for anyone interested in cutting-edge cancer therapies and internal medicine!
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CAR-T Therapy Breakthrough
- CAR-T therapy modifies a patient's T-cells to target malignancies and induce tumor remission through clonal expansion.
- CAR-T represents a breakthrough in immuno-oncology but introduces new side effects like CRS and ICANS.
CRS Pathophysiology and Risks
- CRS arises from massive cytokine release triggering systemic inflammation and organ dysfunction, driven largely by interleukin-6.
- Severity correlates with tumor burden and T-cell activation, occurring in up to 80% of patients.
Understanding ICANS Neurotoxicity
- ICANS is a frequent and potentially lethal neurotoxicity related to CAR-T therapy with unclear pathophysiology.
- Interleukin-1 plays a key role; onset is typically later than CRS, ranging from mild tremors to cerebral edema.