Chimeric Antigen Receptor T Cells: Toxicity and Management Considerations

Chimeric antigen receptor (CAR) T-cell therapies use genetically engineered T cells that mediate T-cell activation and costimulation.^1,2  CAR T-cell therapies can produce sustained remission in hematologic malignancies that are refractory to standard therapies.³  Tisagenlecleucel and axicabtagene ciloleucel are among the first CAR T-cell therapies approved by the US Food and Drug Administration (FDA) for the treatment of acute lymphoblastic leukemia and diffuse large B-cell lymphoma, respectively, and several other CAR T-cell therapies are on the horizon.^2,4,5  In addition to tisagenlecleucel and axicabtagene ciloleucel, currently available CAR T-cell therapies recently approved by the FDA include brexucabtagene autoleucel, idecabtagene vicleucel, and lisocabtagene maraleucel.^6-8  CAR T-cell therapies are designed to recognize and bind to specific antigens on tumor cells, leading to CAR T-cell activation and proliferation and eventually resulting in significant and durable destruction of malignant cells.¹ 

The design of...