Nurses, APPs Key to AE Management as T-Cell Engagers Move Into Solid Tumors

As T-cell engager therapies expand from hematologic malignancies into solid tumors, oncology nurses and advanced practice providers (APPs) play a critical role in managing an evolving spectrum of immune-related toxicities, experts reported at the 2025 Immune Cell Effector Therapies (ICE-T) Conference.

Daniel Carrizosa, MD, MS, a physician at Atrium Health Levine Cancer Institute and associate professor of cancer medicine at Wake Forest University School of Medicine in Charlotte, North Carolina, noted that bispecific T-cell engagers (BiTEs) such as tarlatamab (Imdelltra) in small cell lung cancer can cause adverse effects (AEs) uncommon in solid tumors, including immune effector cell-associated neurotoxicity syndrome (ICANS) and cytokine release syndrome (CRS).

Additionally, Nausheen Ahmed, MD, an associate professor of hematologic malignancies and cellular therapeutics at the University of Kansas Medical Center, highlighted the importance of maintaining normalcy for patients receiving immune effector cell therapies, such as reinforcing cues that preserve circadian rhythm.

Al-Ola Abdallah, MD, a myeloma physician and associate professor director of plasma cell disorder program at the University of Kansas Medical Center, added that CAR T-cell therapy for hematologic malignancies is now associated with AEs not seen in trials, including hemophagocytic lymphohistiocytosis (HLH) and prolonged cytopenias, underscoring the need for early detection and monitoring.

Transcript

Carrizosa: It’s important to always realize that it is a team effort to take care of every one of our patients, especially in [non–small cell] lung cancer and in small cell lung cancer. Tarlatamab is obviously a new drug, so we’re going to be looking at things like CRS as well as ICANS. These are things that we don’t typically see in solid tumors. We’re going to be relying on both our nursing staff as well as our APPs to help recognize this in patients, as well as catch it early and know how to treat it well.

Ahmed: In terms of neurological toxicities [associated with immune cell effector therapies], [another presenter at the ICE-T Conference] brought up a very good point that some of these could be delirium, or some of this could be very simple things, like people being hard of hearing and so they can’t answer your questions properly.

Make sure that the patient has as normal of an environment as possible. If they’re admitted inpatient, have their ear hearing aids in place, very simple things like that, and cues that help the patient maintain a normal sense of day and night. Those things will help to prevent the delirium aspect of it, especially in older patients that may be in admitted inpatient or getting steroids. This will help to balance that.

Abdallah: The more important thing is that to understand the indications of CAR T-cell therapy. That’s the very important thing for nurses and APPs to understand about how to evaluate AEs associated with CAR T-cell therapy short term and long term. Understanding of long-term AEs is very important and critical. Because of the extensive use of CAR T-cell and bispecific T-cell engagers, we’re seeing some rare side effects that we didn’t see as much in clinical trials that may [cause patients to] opt out, like HLH or enterocolitis from diarrhea, and these are challenging AEs. Prolonged cytopenias for patients who have no stem cell boost are also very important AEs. These are toxicities that we’re going to start seeing more because of the CAR T-cell therapy that we’re using in multiple myeloma more often. Knowing these side effects or these complications of the CAR T cell earlier might benefit patient survival.

Ahmed: Nurses and APPs can be the liaisons to understand the signs of CRS, neurotoxicity, and infection. Those are the main things, and that’s a very important role.

This transcript has been edited for clarity and conciseness.