Assessing IEC-EC Severity and the Limits of Steroid Therapy

In this segment the panelists, Dr. Samir Parekh and Dr. Saurabh Mehandru, of Mount Sinai in New York, discuss how severity is judged once endoscopy and histology have confirmed immune effector cell-associated enteritis/colitis (IEC-EC) after chimeric antigen receptor (CAR) T-cell therapy, and how that judgment shapes management. Dr. Mehandru acknowledges that gastroenterologists tend to see the more severe end of the spectrum because patients are referred late, and notes that no criteria have been established to classify the disorder as mild, moderate, or severe, leaving the patient in front of the clinician to govern the approach. He starts with the basics, checking for and repleting the vitamin and micronutrient deficiencies that accompany malabsorption, which alone can begin a patient's recovery. He then cautions against the reflex to treat inflammation with steroids, explaining that steroids suppress recovery pathways as well as inflammation, and that symptoms relapsing on withdrawal signal steroid dependence and the need for other therapy. Dr. Mehandru adds that although some immune-based therapies are borrowed from inflammatory bowel disease, the endoscopic picture is closer to graft-vs-host disease, ranging from normal-appearing mucosa to edema or erythema, with ulceration only rarely seen.

This Insights Video was supported by Janssen Pharmaceutical. Content independently developed and published by OncLive.