NURS-02. CLINICAL MANAGEMENT OF PATIENTS RECEIVING CAR T CELL THERAPY FOR CNS TUMORS

Chimeric antigen receptor (CAR) T cells are an innovative new therapy with proven efficacy in some pediatric cancers such as leukemia and lymphoma, but much less experience in solid tumors, especially tumors of the central nervous system (CNS). Seattle Children’s has three open Phase 1 CAR T cell studies (BrainChild-01, -02, and -03 targeting HER2, EGFR, and B7-H3, respectively) for recurrent/refractory CNS tumors and DIPG (BrainChild-03 only). As of December 2019, four patients have been treated at Seattle Children’s Hospital with CAR T cells infused on a weekly schedule through indwelling catheters into the tumor resection cavity or ventricular system. Given the scrutiny of clinical care needed for Phase 1 studies, we are now able to report detailed clinical information that we have learned during the treatment of these patients. Clinical care includes the judicious use of steroids, the clinical support of patient’s symptoms pre- and post-infusion, and the management of peritumoral edema. We will also discuss the psychosocial support needed for families who travel long distances to receive this therapy compounded by the many emotional components of being enrolled on any Phase 1 trial. Case studies and experience from a Nurse Practitioner role will be provided and discussed.