News
Media
Conferences
Publications
Events
CME/CE
Resources
Career Center
Subscribe

Opinion|Videos|June 5, 2025

Standardized Toxicity Grading: Institutional Protocols for CRS and ICANS

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

Panelists discuss how standardized toxicity grading for cytokine release syndrome and immune effector cell–associated neurotoxicity syndrome helps guide physicians in the timely management and escalation of care, emphasizing the importance of symptom grading and clear institutional protocols for intervention.

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:

Standardized Toxicity Grading: Cytokine Release Syndrome (CRS) and Immune Effector Cell–Associated Neurotoxicity Syndrome (ICANS)

CRS:
Grade 1: Fever, mild symptoms, manageable with supportive care

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

Grade 3: Severe symptoms (eg, multiorgan involvement), requires corticosteroids and tocilizumab

Grade 4: Life-threatening, requires intensive care unit (ICU) care and urgent interventions
ICANS:
Grade 1: Mild symptoms (eg, confusion, agitation), no intervention needed

Grade 2: Moderate symptoms, requires steroids or other interventions

Grade 3: Severe symptoms (eg, encephalopathy, seizures), may require ICU and immunosuppressive therapy

Grade 4: Life-threatening, requires intensive care and urgent interventions

Institutional Protocols:

Prompt grading of symptoms is essential for early intervention.

Clear escalation protocols for managing CRS and ICANS, with specific guidance for steroid administration, monitoring, and ICU transfer if necessary.

Newsletter

Stay up to date on recent advances in the multidisciplinary approach to cancer.

Latest CME

Community Practice Connections™: Empowering Interventional Radiologists in the Emerging Era of Oncolytic Immunotherapies for Melanoma

Community Practice Connections™: Empowering Interventional Radiologists in the Emerging Era of Oncolytic Immunotherapies for Melanoma

Yana G. Najjar, MD; Douglas B. Johnson, MD, MSCI; Rahul A. Sheth, MD, FSIR

Community Oncology Connections™: Beyond Primary End Points – Digging Into Randomized and Real-World Data to Guide Challenging Treatment Decisions in HR+/HER2− Metastatic Breast Cancer | Empire State Hematology & Oncology Society

Community Oncology Connections™: Beyond Primary End Points – Digging Into Randomized and Real-World Data to Guide Challenging Treatment Decisions in HR+/HER2− Metastatic Breast Cancer | Empire State Hematology & Oncology Society

Seth A. Wander, MD, PhD; Girish Kunapareddy, MD

Arkansas Association of Cancer Professionals

Arkansas Association of Cancer Professionals

2 Sessions are Available!

Community Oncology Connections™: Beyond Primary End Points – Digging Into Randomized and Real-World Data to Guide Challenging Treatment Decisions in HR+/HER2− Metastatic Breast Cancer | South Carolina Oncology Society

Community Oncology Connections™: Beyond Primary End Points – Digging Into Randomized and Real-World Data to Guide Challenging Treatment Decisions in HR+/HER2− Metastatic Breast Cancer | South Carolina Oncology Society

Seth A. Wander, MD, PhD; Kit Lu, MD

19th Annual New York GU Cancers Congress®

19th Annual New York GU Cancers Congress®

Maha Hussain, MD, FACP, FASCO; Daniel P. Petrylak, MD

Go to PER in Chicago

In-Person + Virtual Event

Go to PER in Chicago

May 29-31, 2026

Community Oncology Connections™: Beyond Primary End Points – Digging Into Randomized and Real-World Data to Guide Challenging Treatment Decisions in HR+/HER2− Metastatic Breast Cancer | Tennessee Oncology Practice Society

Community Oncology Connections™: Beyond Primary End Points – Digging Into Randomized and Real-World Data to Guide Challenging Treatment Decisions in HR+/HER2− Metastatic Breast Cancer | Tennessee Oncology Practice Society

Seth A. Wander, MD, PhD; Kamel Abou Hussein, MD

Iowa Oncology Society

Iowa Oncology Society

1 Session is Available!

Kansas Society of Clinical Oncology

Kansas Society of Clinical Oncology

1 Session is Available!

A Case-Guided Discussion on Managing Immune Thrombocytopenic Purpura (ITP)

A Case-Guided Discussion on Managing Immune Thrombocytopenic Purpura (ITP)

Cindy Neunert, MD, MSCS; Hanny Al-Samkari, MD; Joseph Shatzel, MD, MCR

Louisiana Oncology Society

Louisiana Oncology Society

1 Session is Available!

Medical Crossfire®: Harnessing the Power of Modern Therapies in Newly Diagnosed Multiple Myeloma

Medical Crossfire®: Harnessing the Power of Modern Therapies in Newly Diagnosed Multiple Myeloma

C. Ola Landgren, MD, PhD; Mohamad Mohty, MD, PhD; Surbhi Sidana, MD

Medical Crossfire®: Improving Patient Outcomes in Myeloproliferative Neoplasms With Novel Therapeutic Approaches

Medical Crossfire®: Improving Patient Outcomes in Myeloproliferative Neoplasms With Novel Therapeutic Approaches

Rami Komrokji, MD; Gabriela Hobbs, MD; John Mascarenhas, MD; Naveen Pemmaraju, MD

Tumor Board: Expert Insights on Managing Classical 𝘌𝘎𝘍𝘙 Mutations, 𝘌𝘎𝘍𝘙 Exon 20 Insertions, and Atypical 𝘌𝘎𝘍𝘙 Mutations in Metastatic NSCLC

Tumor Board: Expert Insights on Managing Classical 𝘌𝘎𝘍𝘙 Mutations, 𝘌𝘎𝘍𝘙 Exon 20 Insertions, and Atypical 𝘌𝘎𝘍𝘙 Mutations in Metastatic NSCLC

Balazs Halmos, MD, MS; Enriqueta Felip, MD, PhD; Julia Rotow, MD

Medical Crossfire®: Integrating Next-Generation Endocrine Targeting Therapies to Improve Outcomes for Patients With HR+/HER2- Breast Cancer

Medical Crossfire®: Integrating Next-Generation Endocrine Targeting Therapies to Improve Outcomes for Patients With HR+/HER2- Breast Cancer

William J. Gradishar, MD, FASCO, FACP; Laura Huppert, MD; Yuan Yuan, MD, PhD

Cases & Conversations™: Transforming AML Care—Precision Strategies, Evolving Therapies, and Clinical Insights

Cases & Conversations™: Transforming AML Care—Precision Strategies, Evolving Therapies, and Clinical Insights

Gail J. Roboz, MD; Hagop Kantarjian, MD; Catherine Lai, MD, MPH; Amer Zeidan, MBBS, MHS

GI Tumor Board—Applying Recent Advances in Biomarker Testing and Treatment in Metastatic Colorectal Cancer

GI Tumor Board—Applying Recent Advances in Biomarker Testing and Treatment in Metastatic Colorectal Cancer

John H. Strickler, MD; Stacey A. Cohen, MD; Aparna Parikh, MD; Kanwal P.S. Raghav, MBBS, MD

Evolving Treatment Strategies in Pancreatic Cancer: Current Standards, Emerging Targets, and the Role of Molecular Testing

Evolving Treatment Strategies in Pancreatic Cancer: Current Standards, Emerging Targets, and the Role of Molecular Testing

Eileen M. O’Reilly, MD; E. Gabriela Chiorean, MD, FASCO; Michael J. Pishvaian, MD, PhD; Brian Wolpin, MD, MPH

Medical Crossfire®: Expert Perspectives on Targeting c-Met Overexpression and 𝘔𝘌𝘛 Genomic Alterations in NSCLC – Unveiling the Complexities of 𝘔𝘌𝘛 Dysregulation

Medical Crossfire®: Expert Perspectives on Targeting c-Met Overexpression and 𝘔𝘌𝘛 Genomic Alterations in NSCLC – Unveiling the Complexities of 𝘔𝘌𝘛 Dysregulation

Rebecca Heist, MD, MPH; Alex A. Adjei, MD, PhD, FACP; Sandip Patel, MD, FASCO; Jeremy Segal, MD, PhD

PER Tumor Board®: Applying Recent Advances to Transform the Treatment Paradigm in SCLC—Expert Perspectives on New Approvals and Emerging Strategies

PER Tumor Board®: Applying Recent Advances to Transform the Treatment Paradigm in SCLC—Expert Perspectives on New Approvals and Emerging Strategies

Jonathan W. Goldman, MD; Percy Lee, MD, FASTRO; Erminia Massarelli, MD, PhD, MS; Misty D. Shields, MD, PhD

Medical Crossfire®: Precision Medicine in Glioma Treatment — Integration of Molecular Profiling to Inform Targeted Therapies

Medical Crossfire®: Precision Medicine in Glioma Treatment — Integration of Molecular Profiling to Inform Targeted Therapies

Vinay K. Puduvalli, MD; Manmeet Ahluwalia, MD, MBA; Stephen J. Bagley, MD, MSCE; Angela Waanders, MD, MPH, MS

$Cases and Conversations™: Sorting Through the Expanding Treatment Options for Patients with Relapsed/Refractory Multiple Myeloma$

Cases and Conversations™: Sorting Through the Expanding Treatment Options for Patients with Relapsed/Refractory Multiple Myeloma

C. Ola Landgren, MD, PhD; Mohamad Mohty, MD, PhD; Surbhi Sidana, MD

Breast Cancer Tumor Board: Targeting TROP2 – Innovations in Triple-Negative Breast Cancer Treatment

Breast Cancer Tumor Board: Targeting TROP2 – Innovations in Triple-Negative Breast Cancer Treatment

Joyce O’Shaughnessy, MD; Matthew P. Goetz, MD; Hope S. Rugo, MD, FASCO

Evaluating the Latest Data and Ongoing Trials for Novel ADC Approaches in TNBC

Evaluating the Latest Data and Ongoing Trials for Novel ADC Approaches in TNBC

Aditya Bardia, MD, MPH, FASCO; Erika P. Hamilton, MD

Establishing the Rationale for ADC and ICI Combinations in TNBC

Establishing the Rationale for ADC and ICI Combinations in TNBC

Virginia Kaklamani, MD, DSc; Tiffany A. Traina, MD, FASCO

Breaking Down the Rationale for Targeting TROP2 in TNBC

Breaking Down the Rationale for Targeting TROP2 in TNBC

Filipa Lynce, MD; Rita Nanda, MD

Dissecting Clinical Trial and Real-World Data for ADCs in TNBC

Dissecting Clinical Trial and Real-World Data for ADCs in TNBC

Filipa Lynce, MD; Rita Nanda, MD

Expert Guidance on Frequently Asked Questions Regarding the Use of ADCs in TNBC

Expert Guidance on Frequently Asked Questions Regarding the Use of ADCs in TNBC

Aditya Bardia, MD, MPH, FASCO; Erika P. Hamilton, MD; Virginia Kaklamani, MD, DSc

Breaking Down the Latest Clinical Data for First-line Maintenance and R/R SCLC

Breaking Down the Latest Clinical Data for First-line Maintenance and R/R SCLC

Rahul Gosain, MD, MBA; Rohit Gosain, MD; Hossein Borghaei, DO, MS

Cross-Disease Integration of Immunotherapy Innovations

Cross-Disease Integration of Immunotherapy Innovations

Ghassan Abou-Alfa, MD, MBA; Laura Williams Goff, MD, MSCI, MMHC, FASCO; Arndt Vogel, MD, PhD

Optimizing Treatment for Biliary Tract Cancers

Optimizing Treatment for Biliary Tract Cancers

Ghassan Abou-Alfa, MD, MBA; Laura Williams Goff, MD, MSCI, MMHC, FASCO; Arndt Vogel, MD, PhD

Broadening the Frontline—Studies Informing the Use of Immunotherapy in Hepatocellular Carcinoma

Broadening the Frontline—Studies Informing the Use of Immunotherapy in Hepatocellular Carcinoma

Ghassan Abou-Alfa, MD, MBA; Laura Williams Goff, MD, MSCI, MMHC, FASCO; Arndt Vogel, MD, PhD

PER Resource Center: Integrating Novel Approaches in TNBC – New Avenues for TROP2-Targeting ADCs and Beyond – Nursing

PER Resource Center: Integrating Novel Approaches in TNBC – New Avenues for TROP2-Targeting ADCs and Beyond – Nursing

Aditya Bardia, MD, MPH, FASCO; Erika P. Hamilton, MD; Virginia Kaklamani, MD, DSc; Filipa Lynce, MD; Rita Nanda, MD; Tiffany A. Traina, MD, FASCO

Expert Roundtable and Panel Discussions: Current and Future Landscape of TNBC

Expert Roundtable and Panel Discussions: Current and Future Landscape of TNBC

Aditya Bardia, MD, MPH, FASCO; Erika P. Hamilton, MD; Tiffany A. Traina, MD, FASCO

Practical Considerations and Future Directions for New Treatment Strategies in SCLC

Practical Considerations and Future Directions for New Treatment Strategies in SCLC

Rahul Gosain, MD, MBA; Rohit Gosain, MD; Misty D. Shields, MD, PhD

Show Me the Data®: New and Emerging Roles for Oral SERD Therapy in the Treatment of ER+/HER2– Breast Cancer

Show Me the Data®: New and Emerging Roles for Oral SERD Therapy in the Treatment of ER+/HER2– Breast Cancer

Ana C. Garrido-Castro, MD; Pedram Razavi, MD, PhD

Navigating Treatment Gaps in SCLC: Relapse, Resistance, and Need for New Options

Navigating Treatment Gaps in SCLC: Relapse, Resistance, and Need for New Options

Rahul Gosain, MD, MBA; Rohit Gosain, MD; Giannis Mountzios ΜD, PhD

Medical Crossfire® in Adjunctive Testing: Charting a New Course in Prostate Cancer Risk Assessment

Medical Crossfire® in Adjunctive Testing: Charting a New Course in Prostate Cancer Risk Assessment

Jason Hafron, MD; Aaron D. Berger, MD; Arpeet Shah, MD

Ready for Radioligand Therapy? Patient Selection and Sequencing Simplified

Ready for Radioligand Therapy? Patient Selection and Sequencing Simplified

Jeremie Calais, MD, PhD; Tanya B. Dorff, MD; Scott T. Tagawa, MD, MS, FACP, FASCO

Imaging Matters: Decoding PSMA PET for Better Decision-Making

Imaging Matters: Decoding PSMA PET for Better Decision-Making

Jeremie Calais, MD, PhD; Tanya B. Dorff, MD; Scott T. Tagawa, MD, MS, FACP, FASCO

Radioligand Therapy 101: The Science Behind the Strategy

Radioligand Therapy 101: The Science Behind the Strategy

Jeremie Calais, MD, PhD; Tanya B. Dorff, MD; Scott T. Tagawa, MD, MS, FACP, FASCO

Working Together: Overcoming Barriers to Optimize Outcomes in Patients Treated With Radioligand Therapy Through Multidisciplinary Care

Working Together: Overcoming Barriers to Optimize Outcomes in Patients Treated With Radioligand Therapy Through Multidisciplinary Care

Jeremie Calais, MD, PhD; Tanya B. Dorff, MD; Nerina McDonald, MSPAS, PA-C; Scott T. Tagawa, MD, MS, FACP, FASCO

BURST CME™ Resource Center: Integrating Novel PSMA-Directed Radioligand Approaches for Diagnosis and Management of Prostate Cancer

BURST CME™ Resource Center: Integrating Novel PSMA-Directed Radioligand Approaches for Diagnosis and Management of Prostate Cancer

Jeremie Calais, MD, PhD; Tanya B. Dorff, MD; Nerina McDonald, MSPAS, PA-C; Scott T. Tagawa, MD, MS, FACP, FASCO

Advances in Managing EGFR-Mutant NSCLC: Applying Evidence Across the Disease Continuum

Advances in Managing EGFR-Mutant NSCLC: Applying Evidence Across the Disease Continuum

Tina Cascone, MD, PhD; Christina Baik, MD, MPH; David Planchard, MD, PhD

Community Practice Connections™: Enhancing Melanoma Outcomes With Intratumoral Oncolytic Immunotherapy–Strategies for the Multidisciplinary Team

Community Practice Connections™: Enhancing Melanoma Outcomes With Intratumoral Oncolytic Immunotherapy–Strategies for the Multidisciplinary Team

Yana G. Najjar, MD; Sapna Patel, MD

A New Era of Targeted Therapy for Advanced NSCLC: Exploring Future Directions for Bispecific Antibodies and ADCs

A New Era of Targeted Therapy for Advanced NSCLC: Exploring Future Directions for Bispecific Antibodies and ADCs

Sandip Patel, MD, FASCO; Myung-Ju Ahn, MD; Giannis Mountzios, MD, MSc, PhD; Zofia Piotrowska, MD, MHS

Navigating Advances in Neovascular Retinal Disease: Translating Evidence to Practice in AMD, DME, and RVO

Navigating Advances in Neovascular Retinal Disease: Translating Evidence to Practice in AMD, DME, and RVO

SriniVas R. Sadda, MD, FARVO; Mark R. Barakat, MD, FASRS; David A. Eichenbaum, MD, FASRS

Enhancing Prostate Cancer Outcomes – The Role of PSMA and Targeted Treatment Strategies

Enhancing Prostate Cancer Outcomes – The Role of PSMA and Targeted Treatment Strategies

Ana Kiess, MD, PhD; Erin Grady, MD, CCD, FACNM, FSNMMI; Himanshu Nagar, MD, MS; Scott T. Tagawa, MD, MS, FASCO, FACP

(CME Track) Antibody–Drug Conjugates in Oncology: The Essentials of AE Management for Better Patient Outcomes

(CME Track) Antibody–Drug Conjugates in Oncology: The Essentials of AE Management for Better Patient Outcomes

Michelle L. Taylor, ANP-BC; Emely Alfaro, DNP, RN, CNS, OCN; Paige Griffith, CRNP; Beth Sandy, MSN, CRNP, FAPO

Trending on CancerNetwork

FDA Clears AI Stratification Tool in HR+/HER2– Invasive Breast Cancer

FDA Approves Zenocutuzumab in NRG1+ Cholangiocarcinoma Post Systemic Therapy

Daraxonrasib Shows Anti-Tumor Activity in Pretreated RAS+ Pancreatic Cancer

Zenocutuzumab Earns FDA National Priority Voucher in Cholangiocarcinoma

Cevostamab May Fill Gap in Multiple Myeloma Armamentarium