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Opinion|Videos|May 29, 2025

CRS Recognition and Intervention: Timing and Clinical Features

Author(s)Samuel Rosner, MD, Ranee Mehra, MD, Michelle Sittig, RN, OCN

Panelists discuss how recognizing and grading cytokine release syndrome (CRS) based on symptoms ranging from mild flulike effects to life-threatening conditions is essential for timely intervention, with early detection being key to managing CRS effectively and preventing progression to severe stages.

Episodes in this series

EP. 1 ES-SCLC vs LS-SCLC: Critical Differences in Disease Burden and Patient Prognosis

EP. 1 ES-SCLC vs LS-SCLC: Critical Differences in Disease Burden and Patient Prognosis

EP. 2 Current Treatment Paradigm: Evolution of First-Line Therapy for ES-SCLC

EP. 2 Current Treatment Paradigm: Evolution of First-Line Therapy for ES-SCLC

EP. 3 Addressing Critical Unmet Needs in ES-SCLC Patient Management

EP. 3 Addressing Critical Unmet Needs in ES-SCLC Patient Management

EP. 4 Emerging Clinical Trials: Novel Approaches in Second-Line ES-SCLC

EP. 4 Emerging Clinical Trials: Novel Approaches in Second-Line ES-SCLC

EP. 5 Institutional Implementation: Setting Up Tarlatamab Administration

EP. 5 Institutional Implementation: Setting Up Tarlatamab Administration

EP. 6 Optimizing Multidisciplinary Coordination for Successful Tarlatamab Implementation

EP. 6 Optimizing Multidisciplinary Coordination for Successful Tarlatamab Implementation

EP. 7 Patient Selection Criteria: Identifying Appropriate Candidates for Tarlatamab

EP. 7 Patient Selection Criteria: Identifying Appropriate Candidates for Tarlatamab

EP. 8 Tarlatamab Administration and Postinfusion Monitoring

EP. 8 Tarlatamab Administration and Postinfusion Monitoring

EP. 9 Essential Patient and Caregiver Education for Tarlatamab Treatment Success

EP. 9 Essential Patient and Caregiver Education for Tarlatamab Treatment Success

EP. 10 Neurological Toxicity Recognition: ICANS Assessment and Management

EP. 10 Neurological Toxicity Recognition: ICANS Assessment and Management

EP. 11 CRS Recognition and Intervention: Timing and Clinical Features

EP. 11 CRS Recognition and Intervention: Timing and Clinical Features

EP. 12 Nonimmune Adverse Effects: Managing Dysgeusia and Fatigue

EP. 12 Nonimmune Adverse Effects: Managing Dysgeusia and Fatigue

EP. 13 Differential Toxicity Profile: Tarlatamab vs Traditional Cytotoxic Therapies

EP. 14 Standardized Toxicity Grading: Institutional Protocols for CRS and ICANS

EP. 14 Standardized Toxicity Grading: Institutional Protocols for CRS and ICANS

EP. 15 Future Research Priorities: Optimizing Tarlatamab Administration and Toxicity Management

EP. 15 Future Research Priorities: Optimizing Tarlatamab Administration and Toxicity Management

EP. 16 Seamless Transitions: Managing the Inpatient to Outpatient Care Continuum

EP. 16 Seamless Transitions: Managing the Inpatient to Outpatient Care Continuum

EP. 17 Complex ES-SCLC Case: Tarlatamab Management Through Toxicity to Clinical Benefit

EP. 17 Complex ES-SCLC Case: Tarlatamab Management Through Toxicity to Clinical Benefit

Summary for Physicians:

Cytokine Release Syndrome (CRS) Recognition and Intervention

CRS recognition:
Commonly occurs within 24 to 48 hours post infusion.

Symptoms include fever, chills, tachycardia, hypotension, dyspnea, and rash.
Grading CRS:
Grade 1: Mild fever and flulike symptoms, manageable with supportive care

Grade 2: Moderate symptoms (eg, hypotension), requires medical intervention (eg, fluids, antipyretics)

Grade 3: Severe symptoms (eg, hypoxia, multiorgan involvement), requires steroids and possibly tocilizumab

Grade 4: Life-threatening, requires emergency management and intensive care unit care
Intervention:
Grade 1: Symptom management (eg, acetaminophen, hydration)

Grade 2: Intravenous fluids, antipyretics, monitoring

Grade 3/4: Corticosteroids, tocilizumab (IL-6 inhibitor), and intensive monitoring

Challenges:

Early recognition is crucial for effective management and preventing progression to severe CRS.

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