The University of Arizona Cancer Center, Tucson, is a National Cancer Institute–designated comprehensive cancer center—the only 1 of 45 comprehensive cancer centers in the United States to serve the state of Arizona. In addition to state-of-the-art cancer care, the center offers research, prevention, education, outreach, and training.
The Oncology Nurse-APN/PA (TON) spoke with Sandra Kurtin, PhDc, RN, MS, AOCN, ANP-C, a nurse practitioner who specializes in treating patients with hematologic malignancies at The University of Arizona Cancer Center as part of a multidisciplinary team. Ms Kurtin is a Lead Advanced Practitioner, Hematology/Oncology, The University of Arizona Cancer Center; Assistant Professor of Clinical Medicine, University of Arizona College of Medicine; and Adjunct Clinical Professor of Nursing, University of Arizona College of Nursing, Tucson.
TON: What is your role at The University of Arizona Cancer Center?
Ms Kurtin: As a nurse practitioner, I maintain a busy clinical practice and serve as a subinvestigator for all clinical trials in our center. I am also finishing up my Doctor of Philosophy degree in nursing and informatics and hope to have this completed by the end of 2018.
TON: What professional initiatives are you involved with?
Ms Kurtin: I am on the Board of Directors for the Myelodysplastic Syndromes (MDS) Foundation, a member of the Medical Advisory Board for CancerCare, and I am involved in initiatives that support patients and caregivers as a volunteer for a number of other patient advocacy groups. I am a Founding Board Member and Treasurer of the Advanced Practitioner Society for Hematology and Oncology (APSHO). I am also an active member of the American Society of Hematology (ASH), the American Society of Clinical Oncology (ASCO), and the Oncology Nursing Society (ONS).
TON: Can you describe your career path?
Ms Kurtin: After graduating from nursing school, I went right into oncology, having been drawn to it during my training. I started working at The University of Arizona in oncology 33 years ago, and I have been a nurse practitioner for 23 of those years.
TON: What are you currently excited about in oncology?
Ms Kurtin: It is a great time to be involved with hematologic malignancies. Across the spectrum from MDS to multiple myeloma (MM), lymphomas, and leukemias, there are many new options for treatment that extend survival and improve patients’ quality of life.
For many years, we have had limited treatment options for acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), and MDS. Today, I can tell patients, “We have finally cracked the code.” The science is finally going from the bench to the bedside, but it has taken many years and enormous efforts on the part of researchers and clinicians to build that bench.
We now have immunotherapies and new targeted therapies. After almost 40 years, we have new drugs for the treatment of AML. Some specific examples of new therapies for this malignancy include the isocitrate dehydrogenase 2 inhibitor, enasidenib (Idhifa); fms-like tyrosine kinase 3 inhibitors, including midostaurin (Rydapt); and a new liposomal formulation of daunorubicin and cytarabine (Vyxeos). The B-cell lymphoma 2 (BCL2) inhibitor, venetoclax (Venclexta), also looks promising for AML. In addition, blinatumomab (Blincyto), a bispecific T-cell–engager antibody against CD19/CD3, and inotuzumab ozogamicin (Besponsa), a monoclonal antibody, have been approved for refractory ALL.
After more than a decade, there are also new drugs that look encouraging for the treatment of MDS, including rigosertib, sapacitabine, luspatercept, and eltrombopag (Promacta).
In 2015, we saw some major advances in the treatment of MM, including several drug approvals by the FDA. Patients with this disease now have access to multiple proteasome inhibitors (ie, bortezomib [Velcade], carfilzomib [Kyprolis], and ixazomib [Ninlaro]), immunomodulatory imide drugs (ie, pomalidomide [Pomalyst], lenalidomide [Revlimid], and thalidomide), and 2 new monoclonal antibodies, daratumumab (Darzalex) and elotuzumab (Empliciti). BCL2 inhibitors and chimeric antigen receptor T-cell (CAR-T) therapies are being studied in MM and look very promising.
A number of new drugs have also improved outcomes for patients with chronic lymphocytic leukemia, including the BruTON’s tyrosine kinase inhibitors ibrutinib (Imbruvica) and acalabrutinib (Calquence), the PI3K inhibitor idelalisib (Zydelig), and the BCL2 inhibitor venetoclax. These drugs allow patients the convenience of oral therapy. There are also the CD20-directed monoclonal antibodies, including rituximab (Rituxan), obinutuzumab (Gazyva), and ofatumumab (Arzerra). Chronic lymphocytic leukemia is an active area of research, and we are learning how to sequence and combine these drugs for better efficacy.
TON: Does your cancer center offer CAR-T therapy to patients with ALL and lymphoma?
Ms Kurtin: We have just completed our accreditation process and hope to provide CAR-T treatment soon. We are building a program that will provide this care primarily in the outpatient setting.
TON: What is your biggest professional challenge?
Ms Kurtin: There has been an explosion of new therapies for patients with hematologic malignancies. In large part, this can be attributed to improved understanding of the diseases themselves. It is challenging to maintain expertise in all of these disease states and the expanding number of therapies available for patients. I try to stay informed by attending annual meetings, such as the ASH Annual Meeting & Exposition, the ASCO Annual Meeting, the Journal of the Advanced Practitioner in Oncology Live Annual APSHO Meeting, and the ONS Annual Congress. In addition, I am involved in professional societies, and I read all of the time. As part of a multidisciplinary team caring for patients, I also learn a lot through my colleagues and through my involvement in clinical trials.
TON: What aspects of your work do you find the most rewarding?
Ms Kurtin: I enjoy being part of the progress we are seeing in the field of oncology and being able to bring new science to patients to improve their outcomes. The past 5 years have been an exciting time to be working with patients who have hematologic malignancies.