Q&A: Nursing Considerations From Immune Cell Effector Therapy Experts

With BiTE therapy entering lung cancer treatment, AEs not normally associated with lung cancer treatment are becoming more common.

As T-cell engager therapies expand beyond hematologic malignancies into solid tumors, oncology nurses and advanced practice providers (APPs) remain essential to navigating an evolving spectrum of immune-related toxicities, according to presenters at the 2025 Immune Cell Effector Therapies (ICE-T) Conference.

Daniel Carrizosa, MD, MS, who practices at Atrium Health Levine Cancer Institute (Thoracic-Pulmonary), and is an associate professor of cancer medicine at Wake Forrest University School of Medicine, both in Charlotte, North Carolina, emphasized that the emergence of bispecific T-cell engagers (BiTE) like tarlatamab (Imdelltra) in lung cancers, adverse effects (AEs) not typically associated with solid tumors such as immune effector cell–associated neurotoxicity syndrome (ICANS) and cytokine release syndrome (CRS) can occur.

Nausheen Ahmed, MD, an associate professor of hematologic malignancies and cellular therapeutics at the University of Kansas Medical Center in Kansas City, Kansas, pointed out that nurses and APPs treating patients receiving immune effector cell therapies should be mindful to support patients by creating a normal environment, such as providing cues that help the patient retain a circadian rhythm or sense of day and night.

Al-Ola Abdallah, MD, a myeloma physician and associate professor director of plasma cell disorder program at the University of Kansas Medical Center, Kansas City, Kansas, highlighted that AEs not found in clinical trials are now emerging in CAR T-cell therapies for hematologic malignancies and should be taken seriously. These AEs can include hemophagocytic lymphohistiocytosis (HLH) or prolonged cytopenias and should be monitored for early on.

Oncology Nursing News: How can nurses and APPs expect the AE profiles of T-cell engagers to vary in solid tumors vs hematologic malignancies?

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 be able to help recognize this in patients, as well as catch it early and know how to treat it well.

Some AEs less commonly observed in clinical trials have emerged in patients receiving T-cell engager therapy for B-cell malignancies.

What supportive care interventions are underutilized for patients dealing with AEs from immune cell effector therapies?

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.

What updates in myeloma and other plasma cell disorders are most pertinent to nurses and APPs?

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.

This transcript has been edited for clarity and conciseness.