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CAR T-Cell Therapies: Survey of Oncology Nurses Reveals Much to Be Learned

Chimeric antigen receptor (CAR) T-cell therapy is a form of immunotherapy in which a patient's own T cells are collected and genetically altered to target cancer cells. Although CAR T-cell therapies have shown encouraging results in patients with acute lymphoblastic leukemia and B-cell lymphomas, they are associated with several serious adverse events, including cytokine release syndrome, neurotoxicity, tumor lysis syndrome, and graft-versus-host disease. 

In light of the growing use of CAR T-cell therapies, i3 Health conducted a survey of hematology/oncology nurses at the Oncology Nursing Society (ONS) 44th Annual Congress in Anaheim, California, in order to assess nurses' familiarity with CAR T-cell therapies and their confidence in managing related adverse events.

Forty (53%) of the 75 hematology/oncology nurses surveyed were completely unfamiliar with tisagenlecleucel (Kymriah®, Novartis), an FDA-approved treatment for patients up to the age of 25 with relapsed/refractory acute lymphoblastic leukemia. Sixteen respondents (21%) only knew its name, and three respondents (4%) indicated that they knew of its approved uses without knowing more. Ten (13%) had an understanding of clinical trial data, while six (8%) were very familiar with tisagenlecleucel.

Twenty-seven respondents (36%) were completely unfamiliar with axicabtagene ciloleucel (Yescarta®, Kite Pharma, Inc.)—an FDA-approved treatment for relapsed/refractory non-Hodgkin lymphoma—and 22 (29%) knew only the name. Eight respondents (11%) knew of its approved use without knowing more. Ten respondents (13%) had an understanding of the clinical trial data, and eight (11%) were very familiar with the medication.

Respondents showed even less familiarity with lisocabtagene maraleucel (liso-cel, JCAR017, Celgene), an investigational treatment for diffuse large B-cell lymphoma. Fifty-seven respondents (76%) had never heard of it. Fifteen respondents (20%) only knew its name, while two respondents (3%) knew only basic information. One respondent (1%) had an understanding of clinical trial data.

With respect to managing common adverse events of CAR T-cell therapy, confidence levels varied according to the adverse event in question. While 36% of oncology nurses felt highly confident in the management of tumor lysis syndrome, confidence levels were lower for other conditions: 23% felt highly confident in the management of cytokine release syndrome, 21% for neurotoxicity, and 20% for graft-versus-host disease.

"Given CAR T-cell therapy's recent FDA approval, oncology nurses are critical to the ongoing assessment, recognition, and management of adverse events," commented Stephanie Jackson, MSN, RN, AOCNS®, BMTCN®, Oncology Clinical Nurse Specialist at the Ronald Reagan UCLA Medical Center. "Based on recent survey results, a statistically significant lack of knowledge currently exists among oncology nurses in the identification of various CAR T-cell products, the management of adverse events, and clinical trial data. Comprehensive strategies are needed to facilitate the knowledge and skills required for successful management of patients receiving these novel therapies."

The majority of respondents (84%) indicated that they would like to receive education on CAR T-cell therapy to enhance their oncology nursing practice.

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