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Doege-Potter — SCE Medical Oncology MCQ

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HardSarcomaDoege-PotterSCE Medical Oncology

Six days after CAR-T therapy, a patient develops expressive dysphasia, tremor and impaired attention. ICE score is 6/10. He is afebrile, normotensive and oxygenating normally after earlier cytokine-release syndrome resolved. What is the most appropriate diagnosis and treatment?

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Correct answer: A — Immune effector cell-associated neurotoxicity; start dexamethasone

The timing, language disturbance, tremor and reduced ICE score after CAR-T therapy are characteristic of immune effector cell-associated neurotoxicity syndrome. Corticosteroids are used for clinically significant ICANS after alternative causes are assessed. Tocilizumab treats cytokine-release syndrome but does not adequately treat isolated neurotoxicity because it has poor central nervous system penetration.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/cancer