Poster Session I: Gene therapy, cellular immunotherapy and vaccination - Biology & translational research
There are currently two approved chimeric antigen receptor (CAR) T-cell therapies used for the treatment of hematologic malignancies [diffuse large B-cell lymphoma (DLBCL) and acute lymphoblastic leukemia (ALL)].
The objective of this study was to assess current clinical practices of hematologist/oncologist (hem/onc) specialists related to CAR T-cell therapy in hematologic malignancies, in order to identify knowledge gaps and barriers to optimal care.
A continuing medical education (CME)-certified clinical practice assessment consisting of 25 multiple choice questions was developed to measure knowledge, skills, attitudes, and competence of hem/oncs regarding CAR T-cell therapy. The survey instrument posted online 12/22/17 and was made available without monetary compensation or charge. Respondent confidentiality was maintained, and responses were de-identified and aggregated prior to analyses. Results were grouped into learning topics to assess the association between the percentage of correct answers, patient load, practice setting, and self-reported confidence. This analysis was conducted using RStudio (R version 3.5.1). Statistical methods used in this analysis included multiple linear regression using Ordinary Least Squares (OLS) estimates and Pearson's chi squared test (statistical significance P < .05 level).
As of February 2019 the activity had 399 hem/onc learners and 219 were included in the outcomes assessment. Hem/onc demonstrated knowledge gaps in the following three areas. Foundational Knowledge: Over half, 61% and 62% did not know the components of a CAR construct or the FDA-approved indication for axicabtagene ciloleucel, respectively. Knowledge of Clinical Trial Data: Over half, 68%, 75%, 68%, and 75% did not know the response rates seen in the ELIANA, ZUMA-1, JULIET, or TRANSCEND trials, respectively. Knowledge and Competence Managing Adverse Events (AEs): Just under half, 44% and 35% did not know signs of cytokine release syndrome (CRS) or neurotoxicity associated with CAR T-cell therapy, respectively. Over half (54%) did not know the role of corticosteroids in managing CRS and neurotoxicity. Advanced Analysis: The variables of patient load and practice setting were statistically significant predictors of the percentage of correct answers, where having a patient load <6 and practicing in the community setting were each associated with lower levels of foundational knowledge and knowledge of AE management. There was not a statistically significant interaction between patient load and practice setting for either learning topic. Controlling for answering all questions, knowledge was statistically significantly associated with confidence in foundational knowledge (P < .001) and managing AEs. For those who answered less than 50% of the questions correctly, 86% and 89% rated their confidence in foundational knowledge and AEs as 3 or lower (scale 1-5), respectively.
This activity found hem/oncs lack knowledge related to CAR T-cell therapy in the areas of foundational concepts, clinical trial data, and managing AEs. Hem/onc who practice in the community setting and hem/onc who see fewer than 6 patients with NHL or B-cell ALL per month had lower levels of knowledge in this assessment, indicating an even higher educational need than academic providers with a higher patient load. Additional education is needed to narrow these knowledge gaps and to improve confidence of academic and community hem/oncs specialists who care for patients receiving CAR T-cell therapy.