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.

COVID-19 Vaccination and Cancer: The Most Critical Issues

“…One particular interest lies in the dual character of anti-tumor treatment for physicians and researchers. For instance, ICIs can activate both innate and adaptive immune systems and they can cause pneumonitis and thrombocytopenia as well [58,59]. Besides, although lung disease and problems are among the most critical risk factors for COVID-19, lung damage is not a common complication of ICIs treatment.…”

SARS-CoV-2 S Protein Binding hACE2: Viral Entry, Pathogenesis, Prognosis, and Potential Therapeutic Targets

“…On the other hand, cancer vaccines were believed to be correlated with minimal toxicity [171,178]. Chimeric antigen receptor T cell therapy can give rise to a serious side effect as cytokine syndrome [179]. Finally, immune checkpoint inhibitors are associated with immune-related adverse reactions that commonly affect gastrointestinal tract, skin, and endocrine glands.…”