8
Management
Table 2. ICANS Recommendations
G2:
ICE score:* 3–6
And/or
Mild somnolence awaking to voice
No Concurrent CRS
• Offer supportive care as per G1
• For high-risk products or patients consider
dexamethasone 10 mg IV × 2 doses (or
equivalent) and reassess. Repeat every 6–12
hours if no improvement.** Rapidly taper
steroids as clinically appropriate once symptoms
improve to G1.***
With Concurrent CRS
• Consider ICU transfer if ICANS associated
with ≥G2 CRS.
• Administer tocilizumab as per G1.
• If refractory to tocilizumab past the first dose,
initiate dexamethasone (10 mg IV every 6–12
hours**) or methylprednisolone equivalent
(1 mg/kg IV every 12 hours). Continue
corticosteroids until improvement to Grade 1,
then rapidly taper as clinically appropriate.***
G3:
ICE score:* 0–2
And/or
Depressed level of consciousness
awakening only to tactile stimulus
And/or
Any clinical seizure focal or
generalized that resolves rapidly
or nonconvulsive seizures
on EEG that resolve with
intervention
And/or
Focal/local edema on
neuroimaging
All G3 patients:
• Transfer patient to ICU.
No Concurrent CRS
• Administer dexamethasone (10 mg IV every
6–12 hours**) or methylprednisolone equivalent
(1 mg/kg IV every 12 hours).
With Concurrent CRS
• Administer tocilizumab as per Grade 1.
• If refractory to tocilizumab past the first dose,
initiate dexamethasone (10 mg IV every 6–12
hours**) or methylprednisolone equivalent
(1 mg/kg IV every 12 hours). Continue
corticosteroids until improvement to Grade 1,
then rapidly taper as clinically appropriate.***
(cont'd)
