For decades, physicians relied solely on the three pillars of cancer care — chemotherapy, radiation and surgery — as the cornerstones of oncologic treatment plans. Over the past 20 years, however, a revolution has taken place in the field of oncology as physicians and researchers develop exciting new options for less invasive treatments that offer better results with fewer side effects.
Physicians with Texas Transplant Institute and Methodist Hospital: (left to right) Jose Carlos Cruz, MD (Adult Blood & Stem Cell Transplant); Paul Shaughnessy, MD (Medical Director, Adult Blood Cancer & Stem Cell Transplant); Cesar Freytes, MD (Adult Blood & Stem Cell Transplant)
San Antonio’s Methodist Healthcare has been on the forefront of this transformation. Affiliations with prestigious organizations such as the Sarah Cannon Research Institute and the Children’s Oncology Group allow oncologists at Methodist Hospital and Methodist Children’s Hospital to enroll pediatric, adolescent and adult patients in an array of clinical trials that make groundbreaking therapies available locally.
“The pace of innovation and new discovery in cancer care mandates access to these types of therapies,” says Lisa Kiehne, MHA, Vice President of Oncology at Methodist Hospital and Methodist Children’s Hospital. “This is no longer the exception but really the standard of care for patients.”
Innovation in Action
Because Methodist Healthcare is recognized for its quaternary blood and stem cell transplant program, including a leading-edge clinical research program, promoting enrollment in clinical trials is a priority for the oncology team.
“Participation in a clinical trial allows patients to receive treatment they would not otherwise receive,” says Paul Shaughnessy, MD, Program Medical Director of the Texas Transplant Institute’s Adult and Pediatric Bone Marrow Transplant Program at Methodist Hospital. “This research advances the standard of care and improves patient outcomes.”
One of the innovative treatments Methodist Healthcare currently provides — and is advancing further through ongoing research — is chimeric antigen receptor T cell therapy (CAR-T cell therapy). This treatment offers hope to blood cancer patients, particularly those with relapse, who may have exhausted conventional treatment options. As a result of CAR-T cell therapy, some patients who failed standard cancer therapy experience long-term survival, Dr. Shaughnessy says.
CAR-T cell therapy uses the patient’s own laboratory-altered T cells to attack cancer cells. Using apheresis, the white blood cells —which include T cells — are filtered from the patient’s blood. A chimeric antigen receptor gene is then added to the T cells, and the T cells are infused back to the patient. The cells bind to an antigen in the patient’s cancer cells, killing the cancer.
According to Dr. Shaughnessy, Methodist Hospital currently has two clinical trials available for relapsed lymphoma and relapsed refractory lymphoma, as well as two additional trials that are anticipated to begin within the next six months.
“We’re seeing patients respond, go into remission and even stay in remission for several years,” he says. “We think that in the next few years, there are going to be a lot of advancements in CAR-T cell therapy. This is probably the biggest area of research in which I’m involved, and it’s a very exciting advancement for our patients. To have it here locally is a great advantage for the community.”
Advancing the Standard of Care
Dr. Shaughnessy has also spent several years researching how to improve stem cell transplants for patients with cancer. In particular, his research has focused on assisting stem cells to enter the bloodstream to minimize the need for bone marrow harvest. Dr. Shaughnessy points to a number of remarkable advancements since his research began. One medication, plerixafor, is now FDA-approved and available to patients. The medication mobilizes stem cells in the bloodstream for collection and eventual autologous transfer.
Dr. Shaughnessy’s research also focuses on minimizing the number of cases of graft-versus-host disease in allogeneic stem cell transplant patients. As the patient’s immune system has already been weakened through previous cancer treatment, immune system cells come almost exclusively from the new stem cells. The new cells regard the patient’s body as foreign, which can lead to potentially life-threatening complications.
Graft-versus-host disease is a common side effect of allogeneic stem cell transplant. Patients who receive donations from a relative have a risk as high as 45% for developing graft-versus-host disease. If the donor and the patient are not related, the risk can be as high as 80%.
“We have trials using new drugs to treat graft-versus-host disease, and we are seeing good results,” Dr. Shaughnessy says. “We want to find ways to improve outcomes, find better ways of treating complications and help patients live longer.”
Progress in Pediatric and Young Adult Oncology
Another groundbreaking clinical trial for pediatric cancer patients, as described by Michael J. Eckrich, MD, MPH, Medical Director for the Pediatric Blood and Marrow Transplant Program at Methodist Children’s Hospital, seeks to minimize the use of radiation during transplant, allowing some patients to avoid radiation’s long-term side effects. Historically, Dr. Eckrich says, radiation was considered the standard of care for pediatric transplant patients, but this trial seeks to establish standards for more judicious use of radiation.
Methodist Children’s Hospital is also one of the few centers in the U.S. taking part in a novel gene therapy trial for patients between the ages of 18 and 25 with sickle cell disease.
“The only cure for sickle cell disease at this point has been bone marrow transplant, and usually it’s been reserved for allogeneic transplants,” Dr. Eckrich says. “This trial uses the patient’s own stem cells to correct their sickle cell and give them back their own cells.”
The trial, which uses the gene-editing technique known as CRISPR, could pave the way for new treatments for sickle cell disease by providing patients with a lifelong autogenic source for red blood cells while also avoiding the potential complications from allogeneic transplants.
Behyar Zoghi, MD, PhD, FACP, is a transplant physician, triple board-certified in internal medicine, hematology and medical oncology. He practices with the Adult Blood and Marrow Stem Cell Transplant program at Texas Transplant Institute and Methodist Hospital, a member of the Sarah Cannon Blood Cancer Network.
Cutting-Edge Technology, Holistic Patient Care
Melding up-to-date technologies with holistic healing is a requirement for a world-class cancer center, Kiehne says.
“I don’t think we can split the two apart,” she says. “We offer patients innovative therapies, high-quality clinical services, and we combine that with other services and care they need as humans to get through a very difficult time in their life.”
To ensure this care is possible for patients, Methodist Hospital and Methodist Children’s Hospital established multilayered infrastructure to care for all aspects of patient health, including pediatric- and adult-designated social workers, child life specialists, dietitians, and psychologists focused on addressing psychosocial needs. Dedicated art therapists and partnerships with local art and music nonprofits see to patients’ emotional needs, and therapy dogs are available to relieve patients’ stress.
“Wraparound care distinguishes our program,” Dr. Eckrich says. “We’re able to use our full complement of services to treat very high-risk patients and produce exceptional outcomes.”
To learn more about blood cancer services at Methodist Healthcare, visit MethodistBMT.com.
Photos courtesy Sterling Creative Photography