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Is MPN Research Still Moving Forward Despite COVID-19?

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Published on June 17, 2020

Has research on myeloproliferative neoplasms (MPNs) halted because of the coronavirus pandemic? Are clinical trials moving forward?
 
In this segment from our recent Answers Now program, host Andrew Schorr talks to MPN experts Dr. Naveen Pemmaraju from the University of Texas MD Anderson Cancer Center and Dr. Jeanne Palmer from the Mayo Clinic Arizona, about this important topic. Watch now to learn more.

This is the second part of a four-part series. Watch Part, 1 at MPN Patient Grateful for Research and Clinical Trials. Part 3 and Part 4 coming soon.

This program is sponsored by Sierra Oncology. This organization has no editorial control. It is produced by Patient Power in partnership with the MPN Research Foundation. Patient Power is solely responsible for the program content.

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Transcript | Is MPN Research Still Moving Forward Despite COVID-19?

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Andrew Schorr:

Greetings from southern California. I'm Andrew Schorr. Welcome to this Answers Now program for those of us living with an MPN, a myeloproliferative neoplasm. And I've been living with myelofibrosis about nine years, so I'm vitally interested. Joining us we'll have a number of experts. There's one of them that just popped on, Naveen Pemmaraju from MD Anderson Cancer Center in Houston, Texas. Dr. Jeanne Palmer joins us from the Mayo Clinic in Scottsdale, Arizona. And also joining us is, way up from Canada, Ottawa Canada, Phil Arner, who like me, has been treated for myelofibrosis.

Okay. Our topic, and we want to thank the MPN Research Foundation for partnering with us, and Sierra Oncology for being an educational supporter of this program. Our topic is the future of MPN research after COVID-19. But I want to talk about during COVID-19 because we don't have an end date on this right now, and so we're worried. So we're going to start with Phil. But first of all Naveen, thank you for being with us once again.

Dr. Pemmaraju:

Thank you, Andrew and Patient Power, for having me.

Andrew Schorr:

Okay. As a physician researcher and Jeanne Palmer thank you for being with us too.

Dr. Palmer:

Yes, thank you for having me.

Andrew Schorr:

We're doing these MPN programs now every two weeks. The time and the date moves around a little. We're going to try to get some consistency there, but we want to thank our experts for being with us.

So, Dr. Palmer, you're in Arizona. Dr. Pemmaraju is in Texas. Both states as we do this live program have rising numbers of people affected by COVID-19, the coronavirus. And while you're cancer researchers, the healthcare system is called upon a lot to treat patients, but yet we want research to move forward and you want to do it. So where are we now? Let's talk about the current situation. Dr. Palmer can you move forward with your research right now in MPNs, so that we can hope for cures, or at least better lines of treatment?

Dr. Palmer:

That's a great question. And Phil, I want to mirror what Naveen said in terms of sharing your story. As an MPN researcher and as a bone marrow transplant physician it always makes me so happy to see this type of outcome happen. And I can really appreciate what you're saying about that five years because I've had a number of patients who I've taken care of for years, and like, "Okay, well when are we going to do transplant? What are we thinking of?" And having that time makes a world of difference. So I'm so happy to hear you had the opportunity to do that.  

Well with regards to COVID and research, there's multiple areas that really this touches. I think first and foremost is the healthcare system. So where we've seen a lot of the brunt of COVID is actually been in the inpatient setting, and in particular in the ICUs. I know that when we first were worried about this back in April, as part of hospital administration as well, I've rarely seen this stress put on the system of how do we increase beds, how do we increase ICU beds?

So when we think of a clinical trial, we really want to think of something that's not going burden that system further. So that's a big piece of it. Again, I think there's a lot of changes that have happened with COVID. For example when this first happened, everyone was scared to leave their house, scared to come to a hospital. Hospitals have gotten a lot better. I know here everybody gets screened before they come in. They get calls, they get COVID swabs before they get - I mean we have so many safety measures in place, that I think the fear of actually physically coming to the hospital is diminishing. And I think our safety is actually quite a bit better now that we're learning more about how this virus spreads.

So that was another big barrier to doing studies. The final thing is resources for doing studies. Different hospitals I know in Arizona and I'm sure this has happened in other places, everyone shut down in April and May, and in the end of March. When a lot of states weren't experiencing the same influx as for example they had in New York. So there's actually resulted in a lot of economic instability for the hospitals, so a lot of times our resources have been cut as a result of that instability.

I think one of the challenges now is going to be, I think people coming in isn't as much a challenge, it's more of making sure we have the resources within our own institution and infrastructure to be able to carry out all the needs of a clinical trial. And then the final piece of it is, does that clinical trial suppress the immune system further? Does this clinical trial put a patient at more risk of having a negative outcome if they have COVID? And that's a big question that we don't know of for a lot of things. But it has crossed my mind in a couple of the trials that we have. Where I'm like, "I know this will immunosuppress somebody further. Do I really want to put them on this study right now with the unknowns of COVID?" And as we learn more hopefully we'll be able to feel more comfortable with some of those decisions.

Andrew Schorr:

Wow. So it sounds like there are trials that are open, and you're having to assess a specific situation to see if you feel comfortable offering it to a given patient.

Dr. Palmer:

Yes. Comfortable with offering it, do people feel comfortable physically coming to the hospital? And then, do we have the resources to do things like imaging studies, and laboratory data, and pathology? Unfortunately we've had a lot of people out on furlough, so I'm stuck with saying, "Okay I need to get a CT scan of the abdomen. Oh, that's going to take two weeks." We can always end up getting it, but it just adds more pressure to the system when we start thinking of some of the examinations and stuff that are done in the setting of a clinical trial.

Andrew Schorr:

Dr. Pemmaraju, you're both at research centers. You're at a huge one there at MD Anderson, but yet there's a spike in COVID cases right in your own county, Harris county. So what about that? Can I feel that you as a researcher are moving forward now? Or will you, or your staff, or resources be deflected in the near term?

Dr. Pemmaraju:

Important question. And as Dr. Palmer was alluding to, at the beginning of the COVID-19 understanding, for most of us early March, we on purpose winded down, tried to shut some things down. We've not opened up primarily most of our research clinical trials. But as Dr. Palmer nicely notes, two or three factors here, patient travel, a lot of our base at MD Anderson are patients from out of state, out of country. We are open and welcome, but patient hesitancy on their own for travel and safety there. And then number two as you nicely alluded Dr. Palmer, this concept of we can do the clinical trial, but what about the correlative studies, pharmacokinetics, pharmacodynamics? Those are tests that it'd be optional on some of the earlier stage studies, but can help you understand how the drug goes.

And then what about the personnel, many of whom were sent home to do work from home, are still there. But at large referral centers such as our at Anderson, and hers at Mayo Clinic, we are fortunate to be the top centers in the world and we are taking patients. I really appreciate what you said also, everyone who comes here at Anderson temperature checks; both employees, doctors, nurses, and patients. Regular availability of COVID testing, that's important which may not have been there for everyone. And then this concept of people really taking these questionnaires seriously. And a little bit of honor system, “Hey if you think you're having fever symptoms to stay at home." Which maybe in the healthcare system we may have prided ourselves on quite the reverse.

"Hey, I'm going to truck through, and work through." Let's not do that anymore moving forward. A final point to what you brought up with clinical trials is the innovation, the ideas. That's something that I think a lot of our patients were worried about. It's probably true that at the beginning of the pandemic, especially for our colleagues in New York, Seattle, and elsewhere, it was difficult to focus on anything but COVID. But I can assure you at least for us, again Mayo Clinic, MD Anderson, yes, the innovations continue. I can tell you two innovations that have happened. Andrew, you'll appreciate both.

One, for people in the wet lab, the actual laboratory pipetting petri dishes, they've moved a lot of their lab meetings all to virtual formats like this, Zoom. So people can interface remotely from home, writing papers, manuscripts, grants. And then two, for Dr. Palmer and I, clinical researchers, we're both coming to work. We are here. We're seeing patients. We're able to have some ability to enroll on clinical trials. So things are moving, things are safe for the most part at all these hospitals. And both Dr. Palmer and I have seen people exactly as you said, delay their care, unfortunately because of said fears. Let's not do that. Come to the hospital for those that need to.

For those that don't need to, those folks can stay at home. But for cancer patients, we're here, open and ready to take care of you.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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