Next generation of cancer treatments: Chimeric antigen receptor T-cell therapy and its related toxicities: A review for perioperative physicians Journal Article


Authors: Echeverry, G.; Fischer, G. W.; Mead, E.
Article Title: Next generation of cancer treatments: Chimeric antigen receptor T-cell therapy and its related toxicities: A review for perioperative physicians
Abstract: Cancer immunotherapy has entered a new era with the recent introduction of genetically engineered T-cells that express chimeric antigen receptors (CARs) capable of recognizing and destroying tumor cells. Several clinical trials in patients with relapsed or refractory B-cell malignancies have demonstrated complete remission rates ranging from 50% to 90%, with long-term data suggestive of a possible curative response. CAR T-cell therapy is currently under investigation for earlier use in these disease processes and in various other solid and liquid tumors. CAR T-cell therapy is associated with a unique postinfusion toxicity profile including cytokine-release syndrome and neurotoxicity. These toxicities are usually reversible but can be fatal, requiring close vigilance and prompt treatment often in an intensive care unit (ICU) setting. CAR T-cell therapy is currently restricted to designated centers possessing expertise in acute toxicity management, but wider use is likely if early therapeutic successes are replicated. As perioperative and critical care physicians, anesthesiologists may encounter such patients in the perioperative or ICU setting and should become familiar with this unique and novel therapeutic modality capable of causing extreme cardiovascular and respiratory compromise. This review will describe the immunobiology of CAR T-cells, their relevance to cancer treatment, clinical aspects of their therapeutic use in cancer chemotherapy, toxicities related to CAR T-cell use, and their therapeutic management.
Journal Title: Anesthesia and Analgesia
Volume: 129
Issue: 2
ISSN: 0003-2999
Publisher: Lippincott Williams & Wilkins  
Date Published: 2019-08-01
Start Page: 434
End Page: 441
Language: English
DOI: 10.1213/ane.0000000000004201
PUBMED: 31124841
PROVIDER: scopus
DOI/URL:
Notes: Article -- Source: Scopus
Altmetric
Citation Impact
MSK Authors
  1. Elena   Mead
    28 Mead
  2. Gregory Walter Fischer
    13 Fischer