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Seattle Cancer Care Alliance opens its doors to share its cellular therapy experience
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The Seattle Cancer Care Alliance, the clinical care partner of the Fred Hutchinson Cancer Research Center, has been at the forefront of cellular therapies for cancer treatment since the field emerged. It was there where E. Donnall Thomas, MD, and his team pioneered the use of bone marrow transplant during the 1970s and SCCA’s position remains unchanged in the field of cellular therapies as its research and clinical staff have administered more CAR T-cell therapies to patients than any other facility in the world.
Terry McDonnell, DNP, ACNP-BC , wears multiple hats for SCCA and the University of Washington School of Medicine, one of the three member organizations that make up the SCCA consortium along with Fred Hutch and Seattle Children’s Hospital. She is chief nurse executive and the vice president of clinical operations and facilities at the SCCA, in addition to being adjunct faculty and a nurse-practitioner at the University of Washington School of Medicine. McDonnell is one of the creators and committee chair of the SSCA’s Evolutions in Immunotherapy symposium taking place later this week in Seattle and she took some time before the event to discuss her role within SCCA’s cellular therapy care team and what attendees to the upcoming event could expect to take away from sharing in the SCCA experience.
Question: Do you work with patients and/or staff in the area of CAR T-cell therapy and other immunotherapies?
Answer: I deal with CAR-T with my administrative hat. I am responsible for the clinical operations for the Bezos Family Immunotherapy Clinic, and I was deeply involved after FDA approval with administration of commercial CAR-T products, Kymriah (tisagenlecleucel; Novartis) and Yescarta (axicabtagene ciloleucel; Kite, Gilead), the first two to market.
We also have a lot of clinical trials going on at the SCCA for new therapies — new CAR T-cell therapies that will hopefully be making their way through the FDA for approval.
Primarily CAR-T has been for liquid tumors. My clinical responsibilities are as a nurse-practitioner for gastrointestinal cancers, so my area of clinical focus is pancreatic and metastatic colorectal cancer. I have not yet participated in the administration of CAR T-cell therapy for my clinical population.
Q: What other forms of immunotherapy/cellular therapy are actively being given or trialed at SCCA?
A: We are the first and longest-providing bone marrow transplantation center. E. Donnall Thomas, MD, won a Nobel Prize for this work here in the development of bone marrow transplantation. Our nurses — originally with Fred Hutch but now under SCCA — were the ones who figured out how to take care of patients throughout these complicated therapies.
The other side of immunotherapy we provide at SCCA are checkpoint inhibitors.
It used to be the case in the clinical environment for GI cancer that there were five conventional chemotherapies that you could give patients. In the last few years we have seen an explosion in checkpoint inhibitors, as well as in our ability to understand the molecular makeup and variance within cancer cells. Every day we learn more and more about the qualities of the cancer cells themselves, which then helps us identify or target the appropriate therapies within the immunotherapy platform that may have clinical benefit.
Pembrolizumab (Keytruda; Merck) and other therapies in this genre have exploded. We’ve seen tremendous benefits in melanoma. We’ve seen some targeted benefit in gastric and head-and-neck cancers. It’s really an exciting time to be participating in oncology care.
Q: What is the window of concern regarding treatment-related toxicity in patients who receive CAR T-cell therapy?
A: We measure this in days; it’s about 3 to 10 days where we monitor the patient heavily after the CAR T-cell infusion.
Q: If the patient is not immediately admitted and released after the infusion, what type of communication goes on between the clinical staff, the patient, and any at-home caregivers?
A: There is constant communication. Some of these patients will require daily communication during the acute phase of therapy. Some of these therapies were initially mandated by the manufacturer to be initially administered as an inpatient, for example, Yescarta, which saw increased risk during their clinical trials. Once they receive the therapy and they are discharged, they are transitioned over to their outpatient team where they continue their monitoring.
One of the things we leveraged here at SCCA was our bone marrow transplantation team care model. The model entails physicians working closely with advanced practice clinicians — nurse-practitioners and physicians’ assistants — as well as nurses and social workers who wrap themselves around the care of the patient and are in constant daily communication with the patient. We leverage this model for our CAR T-cell therapy, and it’s been very, very successful.
Q: Let’s talk about the role of non-physician practitioners, like NPs and infusion nurses at cancer care clinics. Are they a part of the intended audience for the upcoming Evolutions in Immunotherapy symposium being hosted by SCCA later this week in Seattle?
A: Absolutely. What we found when we opened the Bezos Center in 2016 was that we had nurses, many of whom were very seasoned in bone marrow transplantation, who were still figuring out how to manage patients in this new age of CAR T-cell therapy.
The side effects are slightly different. The trajectory is slightly different. With CAR-T you see some of these rapid inflammatory syndromes that were not necessarily part of the experience with bone marrow transplantation.
Our nurses have been at the forefront of watching these trends and establishing the algorithms on how to respond to and manage patients during the brief time they are at greatest risk. Our nurses were involved in writing the playbook on how to treat these patients and because we have given more patients this type of therapy than any other center in the country, about 2 years ago we said it would be beneficial to bring people in from centers across the country to share their experiences on how to best care for these patients. We want to share what we have learned so we can help enhance professional practice for nurses, nurse-practitioners, and other allied professionals who are caring for patients receiving CAR T-cell therapy.
Q: Who could benefit from attending the Evolutions in Immunotherapy symposium?
A: Anyone who participates in the care of these patients, what I consider the other allied professions: social workers, financial coordinators, nutritionists — anyone who participates in the care of these patients can benefit in some way.
We have also invited our network community physicians to attend and participate to learn more about the therapy. CAR T-cell therapy is concentrated to large, academic medical centers, but there is tremendous benefit for community oncologist and their care teams to understand how these therapies are developing and how the patients are managed. Community oncologists will be referring patients for these therapies and they will need to understand what the long-term effects may entail.
Q: Why should I consider spending my time and money to come to Seattle for this event when there are larger events that deal with immunotherapies, like ASCO or SITC?
A: We are the center in this country that has provided the highest volume of these therapies, and at the event we will share our breadth and depth of knowledge. Our doors will be wide open, and we will share everything that we have learned, and there’s large benefits to that approach.
Q: How will this year’s event differ from last year’s symposium?
A: Last year we really focused on CAR-T and this year we want to shift the focus to immunotherapy in total.
What are some key points you hope attendees will take away from the symposium?
A: We hope that a major focus during this symposium will be that of the patient experience, and not just the physician, nurse or state-of-the art practice. We had a patient panel at the event last year and we are going to replicate that again this year. We bring together patients with their providers who have experienced this treatment. They will discuss not only the significant side effects but also the tremendous expenses involved. They will discuss the difficulties in navigating the health care system and how to pull your family through the experience. I think there is something very special in having insight into what the patients experience and not just that of the providers. – by Drew Amorosi
For more information on the Seattle Cancer Care Alliance’s Evolutions in Immunotherapy symposium, visit www.seattlecca.org/imtx_2019 .
For more information:
Terry McDonnell, DNP, ACNP-BC can be reached at tmcdon@seattlecca.org.
Disclosures: McDonnell reports no relevant financial disclosures.