‘You give me fever!’: are health services ready for immune cell engager therapy in advanced solid malignancies?

Immune cell engager therapeutic strategies using bioengineered molecules to redirect immune cells into tumor are starting to demonstrate promising clinical activity in multiple early phase trials across numerous targets and a range of solid tumor types. These therapies, however, carry the risk of exaggerated cytokine-mediated on-target off-tumor adverse events that require highly specialized inpatient facilities. We report here the Royal Marsden experience of treating patients with advanced solid tumors on early phase immune engager clinical trials in a dedicated inpatient facility, focusing specifically on patterns of cytokine-mediated toxicity seen and proposing a risk-mitigation algorithm for the safe, feasible and scalable delivery of these therapies.