Running the “CAR” Shop: Nursing’s Role in Establishing the Intake and Management Standards of Patients Enrolled in CAR T-Cell Clinical Trials

Conference Correspondent  - Conference Correspondent, ONS 2017 - Immunotherapy

Chimeric antigen receptor (CAR) T-cell therapy is an immunotherapeutic approach that has yielded favorable clinical outcomes in various hematologic malignancies. CAR T-cell therapy utilizes gene transfer to reprogram the patient’s T-cells to recognize and eliminate cancerous cells by targeting and interacting with tumor-associated antigens.

T-cells are collected from a patient with cancer via apheresis, and they are then genetically engineered to produce CARs via retroviral or lentiviral CAR transduction. The T-cells, now known as CAR T-cells, recognize and localize with specifically targeted tumor-cell antigens. The CAR T-cell line is expanded and then infused back into the patient. Prior to CAR T-cell infusion, patients usually receive a brief course of chemotherapy to induce lymphodepletion to enhance CAR T-cell persistence and expansion. The CAR T-cells can then remain in the body, preventing cancer recurrence and often resulting in long-term remission.

The promise of CAR T-cell therapy is based on the specificity of the genetically engineered CARs against targeted tumor antigens, the ability to multiply the CAR T-cell population in vivo for intensified antitumor response, and the potential for long-term persistence, resulting in ongoing tumor surveillance and reduced disease recurrence. CAR T-cell therapy has yielded exciting and encouraging results in hematologic malignancies, including acute lymphoblastic leukemia (ALL), chronic lymphoblastic leukemia, and multiple myeloma, by targeting CD19; B-cell non-Hodgkin lymphoma by targeting CD19 or CD20; and acute myeloid leukemia by targeting Lewis Y antigen or CD33. Remission rates ranging from 67% to 90% have been observed in adult and pediatric patients with relapsed or refractory ALL.

CAR T-cell therapy is currently being expanded to solid tumors at Memorial Sloan Kettering Cancer Center. The Cellular Therapeutics Center (CTC) was developed to unite researchers and clinicians conducting clinical trials with CAR T-cell therapy for the treatment of hematologic and solid tumor malignancies. Oncology nurses took the lead in screening clinical trial candidates, developing guidelines for patient management, collecting research data, and establishing a centralized treatment center for this patient population.

Oncology nurses at CTC also established the intake and scheduling process, thereby expediting patient intake and screening. CTC nurses notified patients if they met the inclusion criteria, and scheduled ancillary services for eligible patients. Prior to admitting the patient and starting treatment, CTC nurses collected and distributed the patient’s history, treatment plan, and schedule to the inpatient medical team and nursing staff. The patients were educated on CAR T-cells, the expected hospital course, and probable adverse events. CTC nurses followed patients during inpatient and outpatient care for continuity.

This initiative, led by CTC nurses, improved the transmission of clinical data, refined the collection of research data, and increased patient satisfaction. It also enabled collaboration and insight into the identification and management of CAR T-cell therapy–associated side effects. Patient care and safety were also improved through this initiative.

Halton E, et al. ONS Abstract 425.
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Last modified: May 5, 2017