Title:
Monoclonal Antibody-Induced Cytokine Release Syndrome Management
Category:
Cancer treatment-related symptom and toxicity management
Background/rationale:
Cytokine Release Syndrome (CRS) is an acute systemic inflammatory response marked by fever and organ dysfunction, often triggered by immune-engaging therapies. While historically seen in haematological malignancies like T-cell therapies, the expansion of oncological immunotherapies has led to broader CRS presentation, challenging clinical protocols.
Currently, limited guidance exists for monoclonal antibody (MAB)-induced CRS. Our approach involved collaboration with haematologists and the use of eviQ guidelines and the ESMO handbook. As CRS often occurs post-infusion, educating patients to recognise symptoms and supporting remote monitoring are vital for early detection and intervention.
Methods:
Using eviQ grading and management tools, we observed elevated temperature and hypotension four hours post-infusion. Timely response excluded alternate causes. Steroids delayed symptom onset—dexamethasone demonstrated better efficacy and duration compared to sponsor-preferred hydrocortisone.
Impact on practice:
Following our first CRS case, we updated protocols including increased hydration volumes and initiated 15-minute observations once symptoms emerged. Prompt administration of Tocilizumab was prioritised for Grade 2 CRS. Due to limited ambulance familiarity with Tocilizumab, nurses accompanied patients during hospital transfer to ensure care continuity.
Discussion:
We created an education booklet, conducted follow-ups, and equipped patients with thermometers, BP monitors, and pulse oximeters, along with clear escalation instructions. Our site liaised with eviQ to contribute to ongoing updates in CRS guidance, especially to differentiate MAB-induced CRS from CAR-T responses. This area remains under development and warrants further clinical attention.