Brexucabtagene autoleucel// TECARTUS
CAR-T ( Chimeric antigen receptor -T cell therapy)
MECHANISM OF ACTION
Tecartus is a CD19-directed genetically modified autologous T cell immunotherapy, binds to
CD19-expressing cancer cells and normal B cells. Studies demonstrated that following anti-CD19 CAR T cell engagement with CD19-expressing target cells, the CD28 and CD3-zeta co-stimulatory domains activate downstream signaling cascades that lead to T cell activation, proliferation, acquisition of effector functions, and secretion of inflammatory cytokines and chemokines. This sequence of events leads to killing of CD19-expressing cells.
Route of elimination: none known
MECHANISM OF KIDNEY INJURY
In the clinical trials no mention/ in package insert mention AKI in 6% patient in ZUMA-3. I would think is possible same mechanism with other CAR-T therapies, from CRS leading to hypoperfusion
CLINICAL KIDNEY SYNDROME
n/a
CARDIOVASCULAR ADVERSE EFFECTS
HTN/ Hypotension, arrythmia, edema, VTE , bradycardia , paliptations
LYTE ABNORMALITIES
Hypokalemia, Hypomagnesemia, Hypoalbuminemia, Hyponatremia, Hypophosphatemia
RISK FACTORS
MITIGATION STRATEGIES
if CRS - tocilizumab
SUGGESTIONS
Tocilizumab if CRS
NOTES/COMMENTS
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PHARMACOKINETICS
Molecular Weight
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Volume of Distribution
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Plasma Protein Binding
Metabolism
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Bioavailability
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Half-life elimination
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Time to peak
Maximal expansion in peripheral blood is 15 days after infusion
Excretion
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Dialyzable?
Unknown
REF:
https://pubmed.ncbi.nlm.nih.gov/32242358/
https://pubmed.ncbi.nlm.nih.gov/34097852/
https://pubmed.ncbi.nlm.nih.gov/33827116/
PATHOLOGY SLIDES:
ENTRY UPDATES:
Marco Bonilla
Chicago/USA
Sep 25, 2022