Closing Thoughts on Intralesional Therapy for Melanoma and CSCC

Transcript:

Sunandana Chandra, MD, MS: Dr Pavlick, given the logistical challenges of delivering intralesional therapies, can you describe the way your practice does it so our audience can glean some tips as they try to develop these in their own institutions and hospitals?

Anna C. Pavlick, DO: Sure. I am a big believer in making sure that all of my advanced care providers are very skilled and adept at being able to inject tumors. My NPs [nurse practitioners] have all been trained, so it keeps the clinic flow moving. At the beginning of the day, we will identify which room we’re going to be injecting in. We also let housekeeping knowwe’re going to need them to come up, so we don’t have to deal with a room that’s closed down all day, and it’s appropriately disinfected.

If it looks like it’s a [busy] clinic day, I will schedule these patients toward the end of the day. The patients will come in, get their infusions, and then at the end of the day I will have focused time, where even if I have 2 or 3 patients who are getting injected, we can fill up the rooms because the rooms are all going to get terminally cleaned at the end of the day. We can put patients in rooms, I can inject, my nurse practitioner can inject, and then the patients can leave. I think it takes a village to get this done because it’s a lot of coordination, but if you can do it properly…. You need to schedule appropriately to make it run smoothly.

Nikhil Khushalani, MD: I agree completely. It’s all about the workflow. At our center, we have a designated procedure room within our clinic space itself. So all of these patients come down and get treated there. We try to schedule all of them on the same day so that it’s 1 provider assigned to that and can take care of it all. Then similarly, separately of course, the ones who are in clinical trials are done in our clinical research unit.

I think one of the other potential advantages of intralesional therapies is specifically in that population of patients who are immunosuppressed. The transplant population deserves further investigation with these agents; that’s ongoing. Similarly, patients who have notable autoimmune disorders for whom you are on the fence or hedging about [using] anti–PD-1 [therapy] or immune checkpoint inhibition in general would be appropriate for consideration of intralesional therapy in either of these disease modalities.

Sunandana Chandra, MD, MS: This was a great overview of the current and potentially some near future treatment strategies in advanced cutaneous squamous cell carcinoma and melanoma. Thank you both for your time. I really appreciated talking with you both. Thanks.

Nikhil Khushalani, MD: My pleasure. Thanks for having us.

Anna C. Pavlick, DO: My pleasure.

Transcript edited for clarity.