Not an expert at all but I'm preparing to go through assisting someone with CAR-T therapy soon. This is just from what I've seen with their treatments and visits so far.
In the previous chemotherapy it was dosed at regular intervals and they could make adjustments to the speed of the dose, supplemental medication, and maybe dose size(?) but the close supervision was more or less right around infusion followed by 3 weeks without medical care. With the CAR-T we're looking at about a week of 8 hours every day in the clinic, followed by 3 weeks of slightly fewer days each week. In addition the caretakers (family/friends) are to monitor the patient at all other times for signs of cytokine release and the neurological effects. There are steroids used to reduce the impact of both but they need to be applied fast enough. The patient is supposed to be monitored 24/7 for a month, and for patients who live more than a hour from the clinic they have to stay in a hotel and cannot go home.
It seems more serious than the initial chemo cycle but it seems to me that part of that is because they inject the modified cells then just watch.
Following CAR-T studies earlier from Novartis, I recall that cytokine release as an adverse event was also highly predictive of the treatment's efficacy. So terrible as it is, it's also an indication of the immune system at work.
"Four-day extracorporeal blood purification resulted in complete resolution of immune effector cell-associated neurotoxicity syndrome and greater than 95% reduction in interleukin-6 levels without side effects"
I mean yeah, its about balancing risks. I'm guessing that a ~2% chance of a cascade would mean that its not likley to be given as a first like of defence.
In a lot of cases we don't have other first line options. it may be no treatment die in 6 months, standard treatment die in 10 months, or this where 2% die in 1 month but 98% are cancer free 1 year later. All numbers above made up, but those are often what we are dealing with.
Of course where we have other cancer treatments that works well those should be a first line (at least for now - who knows how this will advance), but all too often we don't have good options.
