Background and importance Chimeric antigen receptor (CAR) T cell therapy is being studied for the treatment of haematologic malignancies. CARs are synthetic receptors that reveal the specificity, purpose and metabolism of T cells. The first step in making CAR-T cells is to insert a gene into the cell in order to express a new antigen binding site on its surface and to redirect the T cell to the new target. Since CAR-T is a personalised therapy, the medicine should be administered to the patient for whom it was intended. For this reason, the clinical pharmacist plays a key role in clinical surveillance, care coordination and patient education.
Aim and objectives The aim of this work was to assess the pharmacist as risk manager in a CAR-T multidisciplinary team comprising professionals who take care of cancer patients. Beyond the implementation of the hospital system, the pharmacist is essential in the follow-up of patients after administration because of the complexity of the side effects as well as antidote management.
Material and methods Cytokine release syndrome (CRS) is one of the most common side effects of CAR-T therapy, in which there is a fast release of cytokines involved in the inflammatory process. It seems that the onset of CRS is related to the efficacy of the therapy, even though this side effect is extremely dangerous and on target. Pharmacists should manage CRS by ensuring the supply of tocilizumab, a monoclonal antibody against interleukin 6 indicated as an antidote, or by using situximab, off-label.
Results Currently, six patients are being treated with CAR-T cell therapy and safety outcomes are ongoing. All have had CRS reactions and received tocilizumab.
Conclusion and relevance Based on these results, the immediate availability of antidote and timely treatment of CRS reactions (mandatory activity for the pharmacist) is necessary to ensure the therapeutic and safety benefits for patients. The study shows the essential role of the pharmacist in covering the risks of this type of therapy and in reducing the seriousness of side effects in an innovative therapy such as CAR-T cells.
References and/or acknowledgements No conflict of interest.
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