CAR T-Cell Therapy Continues to Revolutionize Hematologic Cancer Treatment

The number of FDA-approved CAR T-cell therapies has increased from 3 to 5 drugs in the past year. This new treatment regimen looks promising to continue to evolve in the years to come, offering hope for patients with relapsing hematologic malignancies who have not responded to previous chemotherapy treatments, says Kelly Garvin, BSN, RN , OCN.

In a recent interview with Oncology Nursing News®, Garvin, Department of Malignant Hematology, H. Lee Moffit Cancer Center, discussed his recent presentation on The Drug Landscape at 5th annual Meeting of the School of Nursing in Oncology. She explained how nurses can remain vigilant in detecting adverse events (AEs) related to CAR T and explained how the evolution of CAR T cell therapy has continued to change the prognosis of patients with cancer of the breast. blood and where she hopes the direction of treatment will go.

Oncology Nursing News: How can nurses anticipate and react aggressively to AEs associated with CAR T therapy?

Good question. One thing we do is we have specially trained nurses. Thus, the nurses who work on the CAR T floor are almost intensivists. In other words, we can float the nurses from the ICU to the CAR T cell floor, but we cannot load the nurses from MedSurg to the CAR T.[-cell therapy] ground. Thus, these nurses must first be specially trained to recognize the signs and symptoms of cytokine release syndrome, neurotoxicity and ICANS.

Another thing we do is take vital signs more often. So instead of [taking vitals] once per shift, we do it every 4 hours. We can do a cranial nerve check every time we go. We may be on the lookout for signs like headache, aphasia, or confusion. We can ask the patient to write a sentence and notice if there are any tremors in their calligraphy that could indicate something is brewing. We can take their temperature more often. We can use family members to help us and alert us if the patient seems a little upset. So things like that all work together to keep the patient safe.

Could you tell us how CAR T cell therapy has altered the outcome and prognosis of blood cancer patients?

Oh, that’s what I prefer to talk about. So much has happened recently. Last year I gave this talk and at the time there were only 3 products approved by the FDA for certain malignancies, and 1 of them had been approved a few days before my talk. I actually had to redo all the slides just to include them. Now there are 5 different products and there are more indications.

So if I have a patient who, for example, [has] diffuse large B cell lymphoma, one of the most common non-Hodgkin lymphomas diagnosed in the United States each year, and is very aggressive, [the] the good news is that we can cure about two-thirds of these patients with traditional chemotherapy and archtop immunotherapy. But for the third party who relapses or does not respond, the data is not good. There is not much we can do. Standard of Care says [to] try catch-up chemotherapy, then get them for an autologous stem cell transplant. But if the chemotherapy did not work very well the first time, that is, intensive chemotherapy will work the second time. Right now, a trial is underway at my cancer center to determine if CAR T cell therapy is just as good or maybe even better than the standard of care. So for those patients who maybe have bad prognostic factors, like bad genetics, or maybe they have BCL2 or BCL6 translocation or overexpression, and it doesn’t look like they’re likely to be very respond well to chemotherapy, if we could take these patients, and identify them early and get them to CAR T cell therapy, where we don’t use chemotherapy to fight disease, we use the body and the immune system of the patient, could they have a better outcome? Could their remission be deeper and longer? This is what we are aiming for.

And what do you hope to see in the next 5-10 years?

So many good things. So, one of the hurdles that we have to overcome with CAR T cell therapy is that we use the patient’s own T cells, and we send them to be made and reprogrammed in a way that is better able to fight cancer. . But sometimes this process takes too long. These are patients who have seen multiple lines of treatment. By the time they switch to CAR T cell therapy, they might not be able to wait 2, 4, or in some cases even 6 weeks to get those T cells made for them. So 1 thing we are looking at is allogeneic T cell therapy or [therapy]. So we will have donor T cells, much like we have an allogeneic donor stem cell transplant. It is therefore 1 zone.

Another area is more guidance. Can we use CAR T-cell therapy for other diseases? For example, follicular lymphoma, which often turns into large diffuse B cells [lymphoma], can we use it in follicular lymphoma just like we can in diffuse large B cells [lymphoma] achieve better results for these patients? In reality? Yes. Axicabtagene ciloleucel (Yescarta), the first generation CAR T cell therapy, has also just been approved in this specific context.

Another thing I would like to see maybe use CAR T-cell therapy as my first[-line therapy] rather than in the context of relapse / refractory. So, would it be better to substitute chemotherapy sometimes or replace stem cell transplant in some cases, and start with CAR T cell therapy for some of these patients, especially if they have? TP53 mutations, or other genetic markers that make us think they may not respond very well to chemo? Let’s start thinking: can we use immunotherapy instead? This is what I would like to see.

What’s the big takeaway for oncology nurses from your presentation?

Well, on a very tangible level, nurses who are already doing oncology and seeing patients who have these malignant B cell tumors, multiple myelomas, and diffuse large B cells [and[ follicular or mantle cell [lymphomas], they will know how to prepare the patients they have identified as good candidates for the feel and appearance of CAR T therapy for the patient. So it’s 1 thing.

And for other nurses who may not have lymphoma, I want to leave this idea to them: CAR T-cell therapy is huge. It’s exciting. It’s dynamic. And it’s a great fun place to be in medicine right now. And stay tuned, more are to come.

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