>> DEVELOPMENTAL THERAPEUTICS, ESPECIALLY IN CHILDREN,
HAS CHANGED DRAMATICALLY IN THE LAST 10 YEARS.
WE ARE NOW BRINGING NEW AGENTS TO CHILDREN MORE
QUICKLY THAN WE HAVE IN THE PAST,
AND MORE CHILDREN ARE RECEIVING NEW AGENTS
THAN EVER BEFORE.
>> IF YOU BELIEVE THAT YOU HAVE A PATIENT AT HIGH RISK
FOR RECURRENCE, IF YOU HAVE A PATIENT WHOSE DISEASE
YOU'RE NOT CONTROLLING WELL, MEASURING, FOR INSTANCE,
MINIMAL RESIDUAL DISEASE AND IT'S NOT GOING DOWN QUICKLY
ENOUGH, OR IF YOU HAVE A PATIENT WHOSE JUST RELAPSED,
WHAT I WOULD SAY IS CONTACT US EARLY.
WE WILL WORK WITH YOU.
WE WILL LET YOU KNOW IF WE DO HAVE ANY TREATMENT
OPTIONS FOR YOUR PATIENTS, EITHER AT THAT MOMENT
IN TIME OR AT A LATER POINT.
>> YOU DON'T WANT TO WAIT UNTIL A CHILD HAS BEEN
HOSPITALIZED FOR A LONG PERIOD WITH MULTIPLE
INFECTIONS, MAYBE HAVING KIDNEY OR LIVER PROBLEMS
FROM ALL THE COMBINED CHEMOTHERAPY
THEY'VE RECEIVED.
THOSE KIND OF THINGS ARE WHAT KEEPS A CHILD
FROM GETTING EXPERIMENTAL THERAPY.
>> THE KEY HERE, THE INTENT, IS TO PRESERVE THE OPTION
FOR AS MANY TREATMENT POSSIBILITIES FOR ANY GIVEN
PATIENT AS WE CAN.
AND THE EARLIER WE HEAR ABOUT IT,
THE MORE WE CAN ADVISE THE REFERRING PHYSICIAN ABOUT
WHAT MAY OR MAY NOT BE AVAILABLE.
>> WHAT WE TRY TO DO IS GATHER AS MUCH INFORMATION
ABOUT THE CHILD AND ABOUT THEIR RELAPSED CANCER
AS POSSIBLE.
AND WE DO THAT SO THAT WE CAN TRY TO FIND TREATMENTS
THAT WILL TARGET THE CAUSE OF THE RELAPSE,
AND TO TRY TO, AS MUCH AS WE CAN,
INDIVIDUALIZE OR TAILOR THE THERAPY FOR AN INDIVIDUAL
CHILD AND HIS OR HER CIRCUMSTANCES.
>> CART19 IS THE FIRST EXAMPLE OF ENGINEERING CELLS
TO ATTACK CANCER THAT WE FEEL ACTUALLY HAS IN VERY,
VERY EARLY RESULTS SHOWN SOME REAL ABILITY TO REMOVE
LARGE AMOUNTS OF DISEASE AND TO PUT PATIENTS
WITH NO OTHER THERAPEUTIC OPTIONS INTO REMISSION.
SO THE ESSENTIAL NATURE OF THE CART19 TREATMENT
IS THAT WE HAVE TO GET T CELLS FROM THE PATIENT.
WE CAN ENGINEER THESE CELLS SO THAT THEY BASICALLY
RESTORE THE ABILITY OF THESE CELLS TO GO AFTER CANCER CELLS
AND KILL THEM.
IN ORDER TO MAKE THESE CELLS,
WE HAVE TO HAVE ACCESS TO THESE CELLS.
AND SO IT IS ABSOLUTELY THE CASE THAT IF IT IS CLEAR
THAT YOU HAVE A PATIENT FOR WHOM THERE'S A HIGH
LIKELIHOOD OF THE DISEASE RETURNING,
OR THE DISEASE HAS JUST RETURNED,
THAT IF YOU TREAT THAT PATIENT WITH INTENSIVE
CHEMOTHERAPY MULTIPLE TIMES AND THEN AT THAT POINT SAY
MAYBE IT WOULD BE APPROPRIATE TO CONSIDER CELL
THERAPY IN THAT PATIENT, WHAT WE'RE LEARNING IS THAT
AT THAT POINT YOU ALSO DON'T HAVE ANY T CELLS TO BE ABLE
TO MANUFACTURE.
SO I THINK THE REAL CHANGE IN THINKING
AND OUR CHALLENGE IN EDUCATING FOLKS AND OUR OWN LEARNING
ON THIS IS REALLY ABOUT THE FACT THAT YOU HAVE TO THINK
OF COLLECTING THE CELLS IN ADVANCE.
YOU HAVE TO THINK OF IT IN ORDER.
YOU HAVE TO THINK OF THE COLLECTION OF THE CELLS FIRST,
AND THEN YOU HAVE TO THINK ABOUT GIVING
CHEMOTHERAPY SECOND.
>> WHEN A PATIENT OR THEIR PHYSICIAN CONTACTS US,
WE REALLY WANT TO DISCUSS ALL THE OPTIONS.
WE WANT TO EDUCATE THEIR ONCOLOGIST AS WELL SO THAT
THE ONCOLOGIST CAN ALSO TALK WITH THE FAMILY.
THAT DOCTOR IS SOMEBODY WHO HAS TO BE ON BOARD
WITH THIS NEXT STEP, THIS EXPERIMENTAL THERAPY.
WE NEED TO HAVE A GOOD WORKING RELATIONSHIP
WITH THE ENTIRE TEAM TO GET THE CHILD THE BEST
THERAPY POSSIBLE.
>> SO I THINK THE IDEA IS THAT WE HEAR EARLY ABOUT
PATIENTS WHO HAVE EITHER RECURRENT OR HIGH-RISK DISEASE,
WE HAVE ENTERED INTO A DIALOGUE OF WHAT
MIGHT OR MIGHT NOT BE APPROPRIATE,
WE SEE THE PATIENT IN SECOND OPINION HERE IF THAT'S
SOMETHING THAT ACTUALLY MAKES SENSE FOR THE FAMILY
AND WHAT THE REFERRING DOC ACTUALLY WANTS TO DO,
AND THEN IF WE DO NEED TO COLLECT CELLS FOR POTENTIAL
CELL THERAPY WE GET THAT DONE QUICKLY.
AND THEN WE LET THE PATIENT GO BACK TO THEIR TREATING
PHYSICIAN FOR ANY APPROPRIATE CHEMOTHERAPY
AND THEN BRING THEM BACK FOR ANY POTENTIAL EXPERIMENTAL
THERAPY THAT MIGHT BENEFIT THAT PATIENT.
SO IT'S REALLY AN ATTEMPT TO WORK IN TANDEM WITH
THE REFERRING PHYSICIAN, DO THOSE THINGS THAT THE
PATIENT CAN DO AT THEIR REFERRING INSTITUTIONS,
AND REALLY LIMIT OUR ROLE TO THE THINGS WHERE WE REALLY
HAVE THAT AVAILABLE HERE BUT NOWHERE ELSE.