Toxicity management for patients receiving novel T-cell engaging therapies.

Curr Opin Pediatr 2014 Feb;26(1):43-9

Division of Pediatric Oncology, Children's Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, Pennsylvania, USA.

Purpose Of Review: Recent clinical trials using T-cell engaging immunotherapies such as bispecific antibodies which target T cells and tumor cells, as well as engineered T cells that express targeting and activation molecules known as chimeric antigen receptors, have demonstrated powerful proof of concept. These therapies result in a significant degree of immune activation in the patient, which has correlated with greatly increased efficacy but also with notable toxicity. These therapies produce nonphysiologic T-cell activation, which is the hallmark of these new, highly active treatments.

Recent Findings: We and others have noted cytokine activation profiles that correlate with both toxicity and efficacy in patients receiving T-cell engaging therapies. Effector cytokines such as interferon-γ are elevated, but so are cytokines that are associated with macrophage activation syndrome/hemophagocytic lymphohistiocytosis, such as interleukin (IL)-10 and IL-6. Although corticosteroids can control some of these toxicities, a targeted approach may produce superior toxicity control without interfering with efficacy. One approach we have developed targets IL-6, a key cytokine in the toxicity response, using the IL-6 receptor antagonist tocilizumab.

Summary: Detailed studies of the T-cell activation produced by these novel therapies has led to more targeted approaches that have the potential to control toxicity while maintaining efficacy.

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Source
http://dx.doi.org/10.1097/MOP.0000000000000043DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4198063PMC
February 2014
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