Monitoring and Managing CRS and Neurologic Toxicities with Bispecific Antibodies

This segment focuses on the key safety considerations associated with bispecific antibody therapy, particularly the identification and management of CRS and immune effector cell–associated neurotoxicity syndrome (ICANS). The panel emphasizes that although these toxicities are generally less frequent and severe than those seen with CAR T-cell therapy, early recognition and clear monitoring protocols remain essential for safe treatment delivery.

The discussion begins with practical strategies for identifying early signs of CRS. Fever is typically the first and most common symptom, and clinicians instruct patients to closely monitor body temperature at home, usually using a predefined threshold such as 100.4°F (38°C) to trigger communication with the treatment team. Mild symptoms may be managed with antipyretics or corticosteroids, but persistent fever or additional symptoms such as hypotension or shortness of breath require urgent evaluation and possible hospital admission. The panel stresses the importance of providing patients with 24-hour contact information and clear escalation pathways, particularly in community settings where overnight access to oncology teams may be limited.

The role of caregivers is highlighted as especially important for detecting early neurologic changes associated with ICANS. Caregivers are often the first to notice subtle symptoms such as confusion, word-finding difficulty, or altered behavior. In some centers, telemedicine tools such as video assessments can help clinicians evaluate neurologic symptoms remotely and determine whether escalation of care is needed.

The panel also discusses differences in monitoring between inpatient and outpatient settings. Hospitalized patients typically undergo frequent vital sign assessments and scheduled neurologic evaluations, whereas outpatient monitoring relies more heavily on patient and caregiver reporting of temperature, blood pressure, and symptoms. Home monitoring tools such as thermometers and blood pressure cuffs are strongly recommended.

Finally, the panel reviews treatment approaches for CRS, noting that early use of acetaminophen and corticosteroids, particularly dexamethasone, is often effective, with tocilizumab reserved for persistent or higher-grade CRS. Emerging consensus guidelines are expected to provide standardized recommendations for toxicity grading and management as bispecific therapies become more widely used.