Preparing Patients for PI3K Infusion-Based Therapy
Jennifer L. Garson, PA-C, explains how she helps counsel and prepare patients with follicular lymphoma, like Gerald, for treatment with a PI3K targeted therapy.
PUBLISHED January 21, 2019
Jennifer L. Garson, PA-C: One of the conversations that comes up a lot with patients is…our experience with some of these newer, novel agents. And for Gerry it was a very difficult conversation to come back in and talk about another PI3 [phosphatidylinositol 3] kinase inhibitor after he had such a bad experience landing in the hospital with idelalisib. And one of the things we talked about are the different side effects associated with each of these different PI3 kinase inhibitors. And I know there’s always a lot of apprehension for patients when they have a bad experience with one drug to kind of jump in and be agreeable for another drug that may cause potentially similar side effects. So there was always a lot of discussion about how the mechanism of action is different with these drugs, especially the one he’s on now, and what we would expect as far as side-effect profile.
Currently Gerry is on a drug called copanlisib, which is an infusional type of PI3 kinase inhibitor. And the side-effect profile is a little bit different than the one that he had been on previously and had trouble with. The biggest side effects that we were going to be experiencing with this, we thought, were going to be transient hypertension and high blood sugars.
And so, Gerry was kind of the perfect patient to put on this drug because he doesn’t have a lot of comorbidities. He has not experienced a lot of uncontrolled hypertension, he doesn’t have diabetes. And so we weren’t expecting to see any real significant side effects from that standpoint. But again, with this drug, we can see some of that hepatotoxicity or liver toxicity that he had seen with the idelalisib, as well as some of the pneumonitis and colitis, even though it’s a lot less with this particular drug. I think from the patient perspective, it’s kind of a lot of reassurance from our end of things moving into this.
Gerald Koch: Yes.
Jennifer L. Garson, PA-C: For Gerry, one of the big drawbacks to this was that it was an infusional therapy versus an oral therapy. And so for a gentleman who is working the night shift and has a great quality of life at this point, it’s a really hard sell sometimes to say, “Can you come in once a week and do this?” Especially within our first cycle of treatment, we were very cautious in administering this drug to him, knowing that some of these side effects can peak at about five hours into the infusion. So if you remember way back when…about 16 cycles ago.
Gerald Koch: I do.
Jennifer L. Garson, PA-C: We used to spend a lot of time together in the clinic. For about three weeks he was spending his entire Wednesday with us because we were monitoring him, even though the infusion was only an hour long. So I think there’s a lot of buy-in from the patient that we have to get in order to use some of these newer treatments, especially when they’re infusional. Any concerns going into this new drug?
Gerald Koch: I was a little apprehensive, but you guys reassured me that you think that this was the right path for me to take. And after the first treatment I’m like, “Hey, I can do this.” And once again, the biggest negative to this treatment I’m on now is the time commitment. Every Wednesday I’ve got to go in there for three weeks, so you’ve got to kind of plan your schedule around that. And as I said, I work nights, and sometimes I have to go in the morning, sometimes I could schedule the afternoon. But that’s the biggest thing right now. Luckily, I don’t have any severe side effects. You know, you think of cancer and people losing their hair, and throwing up, and all that other stuff that you hear about, especially from years past. I haven’t experienced any of that, so that’s the most positive part of it. The time commitment — if I could get rid of that, I’d be home-free.
Jennifer L. Garson, PA-C: We’re working on it. We really are working on it. The unfortunate thing with indolent lymphoma is that this is more of a chronic disease. And after first-line treatment, our duration of response dramatically decreases with each line of therapy. So I know from Gerry’s standpoint, he maybe feels at this point that we’re always jumping from treatment to treatment to treatment without a lot of breaks in between. As I said, one of the big components in making patients understand why and what we’re doing is to really outline the mechanism of action, the side-effect profile, and how we can best manage that to keep their quality of life as best as they want it to be at that point.