Dr. Ciara Freeman provides an overview of what patients and care partners can expect before CAR T-cell therapy—from deciding if CAR T is right for you to getting physically and emotionally ready for the road ahead. Dr. Freeman shares how simple advice like remaining active, eating well, and staying closely connected with your care team can make a real difference in both recovery and results.
Dr. Ciara Freeman is an Associate Member and Clinical Research Medical Director in the Department of Blood and Marrow Transplant and Cellular Immunotherapy at Moffitt Cancer Center in Tampa, FL. Learn more about Dr. Freeman.
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Transcript
Laura Beth Ezzell:
What can the patients expect prior to the CAR T-cell therapy process?
Dr. Ciara Freeman:
So, the first thing is a patient will come to a physician like me, and we’ll have a discussion, and we’ll review their history to date, and everything that has happened; the kinds of therapies that their disease has seen, or not seen, if it were.
And then evaluating what makes the most sense to that patient, and whether that’s a clinical trial, or whether that’s a CAR T that’s commercially approved by the FDA, and then selecting the right fit for that patient.
There’s usually a period of evaluation where we make sure that the patient is in good condition, that they could handle the physiological challenge of the aftermath of after we put those Navy SEALs in; although we’ve shown that if you optimize the patients well, even patients who are older do very well with CAR T-cell therapy.
After that period of evaluation, we’ll then obviously take the cells out, and send them off, if they’re getting manufactured outside the patient’s body. And then, as I said, this bridging therapy, this treatment to keep their disease in check, between when we send the cells off and when we get the cells back. Education is critical. So, patients and care providers need to understand the timelines. And obviously, we spend a lot of time explaining the potential side effects, and the importance of staying engaged with their care team.
We have a fully outpatient program here at Moffitt. So, we don’t routinely admit everyone, which is great for patients. They tend to eat better, sleep better, move around more, and they do extremely well. And then, in terms of providing advice for patients and their care partners, we prepare them really extensively, both medical and practical.
We make sure they have a reliable care partner. We plan things very carefully. We make sure they ask their questions early. And we also have a lot of focused initiatives looking at nutrition, activity, and prevention of an infection, because obviously, patients who are really informed tend to do better, not just physically, but also mentally and emotionally.
Laura Beth Ezzell:
Yeah, absolutely, and glad that you’ve kind of gone into this preparation involved to get ready, because I’m curious, what advice do you have or do you share with patients and caregivers on how to best prepare during the time before therapy?
Dr. Ciara Freeman:
So, we actually had a number of investigational trials that we had here at Moffitt, in preparing patients for therapy. So, we had what’s called a prehabilitation trial. That was where we basically picked our only our older patients. You had to be over the age of 65 to be enrolled, and we basically gave them a prescriptive strength training and exercise training regimen to do while they were preparing for CAR T.
And what we found was that patients not only were engaged and very motivated, and felt really empowered by this approach, but they also seemed to have a reduced length of stay. So, you’re in the hospital for a shorter period of time compared to sort of matched peers, and they had a better overall experience. The feedback that we got from patients was extremely positive, and we had very little in the way of any side effects.
So, certainly, it’s something that I encourage my patients to do. The answer absolutely is be active, move about, use your muscles, because a lot of the patients have been on multi-agent treatment, high dose steroids for a really long time. And so, they’ve lost a lot of their muscle mass.
And so, that’s going to sort of mitigate their ability to recover quickly after CAR T. Same thing, we have a study open right now, looking at the effect of dietary intervention prior to CAR T. So, we’re looking at a ketogenic diet, and whether that will improve their basic recruits. We make them fitter by putting them on a diet. And so, that’s a really exciting study that we’re doing right now.
Again, patients love it. We provide all their meals. So, they don’t have to worry about cooking or anything for the whole time. It’s all done work with our fantastic nutrition team and our research kitchen. And so, that’s obviously something else that I feel very strongly about, is the importance for patients to eat well, to eat good food that is good for their bodies. And we’ll see whether we can sort of make those T cells fitter with that intervention. It’s going to be exciting to see those data come out.