Chimeric Antigen Receptor T-Cell Therapy: Promise of a New Cancer Treatment and the Challenges of its Toxicities Across the Lifespan
Sponsored by INS Oncology Special Interest Group
Summary Abstract:
This 3 hour workshop will be an opportunity for neuropsychologists to learn about Chimeric Antigen Receptor T-Cell Therapy (CAR T), a novel treatment for cancer. The treatment involves engineering an individual’s immune system to attack cancer cells and has shown remarkable promise in combatting malignancies. However, the therapy also induces a massive immune response in the host that can trigger a striking neurocognitive syndrome in the acute phase of treatment. Immune effector cell-associated neurotoxicity syndrome (ICANS) often include focal neuropsychological deficits such as aphasia, agraphia, and can progress to produce tremor, encephalopathy and potentially fatal brain edema. The syndrome has both acute and subacute manifestations, but improved understanding and management of these toxicities has provided many people an opportunity for long term survival, raising questions about long term risk of neuropsychological outcomes.
The speakers in this workshop include an internationally recognized neuro-oncologist who is a leader in this field. He will introduce the mechanisms of oncologic therapy and the manifestation and management of acute toxicities. A pediatric neuropsychologist will review the literature on neuropsychological syndromes and outcomes in children, and an adult neuropsychologist will review this literature in adults. Both have ongoing studies of cognitive and behavioral outcomes for patients undergoing CAR T that they will feature in their presentations. The speakers will focus on educating neuropsychologists across specialties and drawing connections with other immune-related neurocognitive conditions (e.g., immune/inflammatory mechanisms related to chemotherapy and COVID-19 related cognitive impairment) and potential applications of CAR T treatments of relevance for neuropsychologists (e.g., infectious disease, multiple sclerosis and other autoimmune conditions). Gaps in the literature, issues of diversity, equity and inclusion in CAR T research, and promise for the future will be discussed as a panel.
Number of Credit Hours: 3.0
Level of Instruction: Intermediate
Learning Objectives:
1. Describe the mechanisms of action and neural toxicities of CAR T therapy
2. Describe risk factors for post-CAR T neuropsychological difficulties and long term outcomes in pediatric and adult oncology patients
3. Integrate knowledge of CAR T with similar conditions that cause immune-mediated neuropsychological symptoms
Presenter(s):
Michael Parsons, PhD
Massachusetts General Hospital/Harvard Medical School
Michael W. Parsons, PhD, ABPP is a clinical neuropsychologist in the Pappas Neuro-Oncology Center and Associate Professor in the Departments of Psychiatry and Oncology at Massachusetts General Hospital/Harvard Medical School. His clinical and research activities focus on the cognitive and behavioral consequences of cancer and cancer therapy. His research involves the use of cognitive assessments and advanced brain imaging techniques to understand how cancer and its treatment affects neural systems and the efficacy of treatment for these problems. He is the author of numerous peer reviewed manuscripts and book chapters related to these issues. He provides neuropsychological evaluations for adults with cancer, addressing the cognitive issues that are caused by cancer and its treatment. He is a past co-chair of the Oncology Special Interest group of the International Neuropsychological Society and currently serves as the communication coordinator for that group. Dr. Parsons is a Diplomate of the American Board of Clinical Neuropsychology and the American Board of Professional Psychology.
Jorg Dietrich, MD PhD
Massachusetts General Hospital
Jorg Dietrich, MD PhD, is the Clinical Director of the Cancer & Neurotoxicity Clinic and Director of the Brain Repair Research Program at the Massachusetts General Hospital (MGH) Cancer Center, Associate Professor of Neurology at Harvard Medical School, and Attending Physician at MGH.
His clinical interests are management of patients with benign and malignant brain tumors and neurologic complications of cancer therapy, including toxicity from radiation, chemotherapy, and immunotherapies, such as CAR-T cell therapies. His research activities include clinical, translational, and basic research in the fields of brain tumor biology, biomarkers of cancer, neurotoxicity from cancer therapies and brain repair mechanisms.
Dr. Dietrich is the author of over 200 publications, including original research articles, review papers, book chapters and other scientific contributions. His work has been supported by the National Institute of Health, the American Cancer Society, the American Academy of Neurology, and other foundations.
Hannah-Lise Schofield, PhD
Children's Hospital of Philadelphia/University of Pennsylvania
Dr. Schofield is a board-certified pediatric neuropsychologist. She provides clinical services in neuropsychology within the Division of Oncology/DCAPBS at the Children’s Hospital of Philadelphia, where she is also involved in administration, teaching, and clinical training. She is an Assistant Professor of Clinical Psychiatry within the Perelman School of Medicine at the University of Pennsylvania. Dr. Schofield serves as the Primary Investigator on two funded studies examining neuropsychological outcomes of pediatric cancer patients receiving hematopoietic stem cell transplant (HSCT) and chimeric antigen receptor (CAR) T-cell therapy. She collaborates on multidisciplinary clinical trials through the Children’s Oncology Group (COG) and consults with research teams designing studies on cognitive outcomes of cellular therapy.
