CRS in the clinical setting

Abstract

Cytokine release syndrome (CRS) is a relatively common side effect of CAR-T cell infusion therapy, presenting as mild to moderate symptoms (fever, etc.) in many patients receiving CAR-T therapy. However, in some patients, severe hypotension and dyspnea may be induced, and symptoms may develop rapidly and become severe without appropriate intervention.

On the other hand, in addition to CAR-T therapy, there have been recent developments of bispecific antibodies (BiTE, etc.) that recognize CD3 on T cells and other specific proteins (antigens) expressed on tumor cells, and CRS has been reported to occur even in such novel immune antibody therapies. Although approved for hematologic tumors at this time, there are many types and varieties, and development in solid tumors is currently progressing rapidly, making this the fastest growing area of anticancer drug development in the past few years.

Initial treatment of CRS involves symptomatic treatment of individual signs and symptoms or suppression of the excessive inflammatory response by administration of corticosteroids and other drugs. However, in more severe cases, treatment with anti-cytokine therapy is commonly used to control excessive increases in blood cytokine levels. With the increase in the diversity of drugs and the broadening of the scope of drug development, the response to CRS is becoming more important in medical practice than ever before. In solid tumors, while referring to the response to CRS in drugs for hematologic tumors as in the past, there is a need for a more individualized response to symptoms and development, taking into account inter-individual and inter-drug differences, and a practical system needs to be established based on each and every experience. In this symposium, we would like to discuss how to provide safe and effective treatment to patients, taking into account the actual situation in the medical field in Japan.