Chimeric antigen receptor (CAR) T-cell therapy is at the forefront of care for a specific subset of patients with cancer. However, the severe side effects of this highly specialized treatment require unique management. During a session for the inaugural ONS Bridge™ virtual conference, Kathleen McDermott, RN, BSN, OCN®, BMTCN®, of Dana-Farber Cancer Institute, discussed how oncology nurses can temper the storm of CAR T-cell therapy.

Generating Super Soldiers: CAR T-Cell Production

McDermott described CAR T-cell therapy as the development of “special ops” for the immune system. In this immunotherapy, a sample of a patient’s own T cells are taken from the blood, and then altered to generate CARs on their surface. The CAR T cells then get reinfused into the patient, where they target specific tumor antigens.

According to McDermott, these super soldiers respond to their environment, making them more dynamic and persistent than conventional pharmaceutical treatments. The Dana-Farber Cancer Institute website contains additional information about CAR T-cell therapy and its mechanism of action.

Quelling Expectations Education

Because CAR T-cell therapy is highly publicized, McDermott emphasized the importance of ensuring patients receive education and vetted materials.

“Patients and families are reading in the media that CAR T treatment is the new ‘miracle drug,’” McDermott said. “This is leading to misconceptions and queries because they are not fully understanding details of who will benefit: Relapsed refractory acute lymphoblastic leukemia (ALL) in children and young adults and diffuse large B-cell lymphoma in adults.

“They also are looking for this treatment at their local facilities,” she added. “They are not aware that because of its unique and potential life-threatening side effects, it is only available at certified CAR T centers. Nurses need to be aware of CAR T indications, side effects, and referral processes to educate and guide their patients and families.”

Forecasting the Storm to Improve Patient Outcomes

Emphasizing the critical role of nurses in preparing for “squalls and aftershocks,” McDermott likened the CAR T-cell therapy experience to a brewing storm. “Nurses are at the frontline to anticipate, recognize, and assess CAR T toxicities. They need to have a clear communication pathway with their CAR T team for notification of any subtle changes.”

CAR T toxicities may include:

  • Cytokine release syndrome (fevers, blood pressure changes, dyspnea, hypoxia)
  • Neurotoxicity (delayed response to questions, word findings issue, excessive sleepiness, confusion, gait issues)

McDermott concluded with a forecast of future directions for CAR T-cell therapy. “In the coming years, research will lead to the development and manufacturing of safer CAR T agents, not only for expanding the list of hematologic malignancies but solid tumors as new targets are identified.” 

“CAR T programs are building on past research to institute prophylactic strategies to improve toxicity management with tumor debulking and cytokine inhibitors,” McDermott said. “Under investigation also are universal (off-the-shelf) CARs agents, which may assist in overcoming the issues of manufacturing cost and inefficiencies.”